Provider Demographics
NPI:1992472666
Name:POWERS, RATANA RUTH (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:RATANA
Middle Name:RUTH
Last Name:POWERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:RATANA
Other - Middle Name:RUTH
Other - Last Name:NHEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25129 VAN LEUVEN STREET
Mailing Address - Street 2:
Mailing Address - City:LOMA LINOA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-583-4997
Mailing Address - Fax:951-306-9587
Practice Address - Street 1:18925 NAVAJO ROAD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-961-0112
Practice Address - Fax:760-240-4371
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14308183500000X
CA50261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist