Provider Demographics
NPI:1053606574
Name:FOWLER, RYAN J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:FOWLER
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 1:1615 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2367
Mailing Address - Country:US
Mailing Address - Phone:360-414-7451
Mailing Address - Fax:360-414-7366
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-414-7451
Practice Address - Fax:360-414-7366
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00060284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist