Provider Demographics
NPI:1669235008
Name:DALAGAN, RYAN GOLDEN LALUNA (RPH)
Entity type:Individual
Prefix:
First Name:RYAN GOLDEN
Middle Name:LALUNA
Last Name:DALAGAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 SW 17TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1013
Mailing Address - Country:US
Mailing Address - Phone:786-832-0775
Mailing Address - Fax:
Practice Address - Street 1:502 SUNPORT LN STE 550
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-8125
Practice Address - Country:US
Practice Address - Phone:786-832-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist