Provider Demographics
NPI:1306631015
Name:RYAN, DEBRA LYNN (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:RYAN
Suffix:
Gender:F
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED PHARMACIS
Mailing Address - Street 1:4628 BUCKHORN RDG
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6171
Mailing Address - Country:US
Mailing Address - Phone:571-426-6595
Mailing Address - Fax:
Practice Address - Street 1:10903 NEW HAMPSHIRE AVENUE
Practice Address - Street 2:BUILDING 22 ROOM 3430
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20993-0002
Practice Address - Country:US
Practice Address - Phone:301-796-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist