Provider Demographics
NPI:1619363892
Name:PUGH, RYAN J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:PUGH
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 1:306 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-1918
Mailing Address - Country:US
Mailing Address - Phone:478-396-0417
Mailing Address - Fax:
Practice Address - Street 1:1880 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3612
Practice Address - Country:US
Practice Address - Phone:478-975-9677
Practice Address - Fax:478-975-9273
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist