Healthcare Provider Details

I. General information

NPI: 1104675933
Provider Name (Legal Business Name): RAYAN PAUL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 POLIFKA DR BLDG 1406
SHAW AFB SC
29152-5100
US

IV. Provider business mailing address

420 POLIFKA DR BLDG 1406
SHAW AFB SC
29152-5100
US

V. Phone/Fax

Practice location:
  • Phone: 803-895-6466
  • Fax:
Mailing address:
  • Phone: 803-895-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberE-101566
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: