Provider Demographics
NPI:1851834022
Name:GRIES, RYAN RAYMOND (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:RAYMOND
Last Name:GRIES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N CENTRAL AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1844
Mailing Address - Country:US
Mailing Address - Phone:602-344-8704
Mailing Address - Fax:602-344-6556
Practice Address - Street 1:1101 N CENTRAL AVE STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1844
Practice Address - Country:US
Practice Address - Phone:602-344-8704
Practice Address - Fax:602-344-6556
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0206461835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care