Healthcare Provider Details

I. General information

NPI: 1861965485
Provider Name (Legal Business Name): RYAN QUINN PENEYRA GUILARAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RYAN PENEYRA GUILARAN PHARMD

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 06/02/2025
Certification Date: 05/29/2025
Deactivation Date: 05/07/2025
Reactivation Date: 05/27/2025

III. Provider practice location address

1220 WASHINGTON AVE
ALBANY NY
12226-1800
US

IV. Provider business mailing address

1220 WASHINGTON AVE
ALBANY NY
12226-1800
US

V. Phone/Fax

Practice location:
  • Phone: 518-445-6176
  • Fax:
Mailing address:
  • Phone: 518-445-6176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064400
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: