Healthcare Provider Details

I. General information

NPI: 1144284746
Provider Name (Legal Business Name): RYAN J MCCLOSKEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

15908 NE 4TH WAY
VANCOUVER WA
98684-3335
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2115
  • Fax:
Mailing address:
  • Phone: 360-241-6043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH42773
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: