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General NPI Number Information
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NPI Number | 1043932775
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Entity Type | Individual
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Provider Name | RYAN GEORGE BOUSQUET PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 100 N MAIN ST # D
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City | CARVER
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State | MA
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Zip | 02330-1089
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Country | US
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Telephone | 401-477-9052
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Fax |
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Provider Business Mailing Address
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Address Line | 22 MARTINS WAY
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City | LINCOLN
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State | RI
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Zip | 02865-1304
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Country | US
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Telephone | 401-477-9052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH240415
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License Number State | MA
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