Healthcare Provider Details

I. General information

NPI: 1972017028
Provider Name (Legal Business Name): RYAN PETERSEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S GARDEN WAY STE 350
EUGENE OR
97401-8179
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 541-746-6816
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax: 702-838-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH-0014161
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: