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General NPI Number Information
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NPI Number | 1902214109
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Entity Type | Individual
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Provider Name | RYAN BACA PHARM D
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Gender | Male
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 116 LUCY LN
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City | WAYNESBORO
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State | VA
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Zip | 22980-3275
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Country | US
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Telephone | 540-932-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 19218 THOMAS NELSON HWY
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City | FABER
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State | VA
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Zip | 22938-2667
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Country | US
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Telephone | 505-603-8172
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202220261
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License Number State | VA
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