1861965485 NPI number — RYAN QUINN PENEYRA GUILARAN PHARMD

Table of content: RYAN QUINN PENEYRA GUILARAN PHARMD (NPI 1861965485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861965485 NPI number — RYAN QUINN PENEYRA GUILARAN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUILARAN
Provider First Name:
RYAN QUINN
Provider Middle Name:
PENEYRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUILARAN
Provider Other First Name:
RYAN
Provider Other Middle Name:
PENEYRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1861965485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/07/2025
NPI Reactivation Date:
05/27/2025

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12226-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-445-6176
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12226-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-445-6176
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  064400 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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