MEDICARE: DR. LAURAJO RYAN PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	39199	TX

General Provider Information

NPI Number	:	1619974912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURAJO RYAN PHARM.D.

Provider Business Mailing Address
First Line	:	9134 VICTORY PASS DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4028
Country	:	US
Telephone Number	:	210-690-1778
Fax Number	:

Provider Business Practice Location Address
First Line	:	7703 FLOYD CURL DR
Second Line	:	MSC 6220
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3901
Country	:	US
Telephone Number	:	210-567-8320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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