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General NPI Number Information
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NPI Number | 1285888966
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Entity Type | Individual
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Provider Name | RYAN D BOUCHARD PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 100 MAIN ST
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City | WHITESBORO
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State | NY
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Zip | 13492-1027
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Country | US
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Telephone | 315-796-7470
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Fax |
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Provider Business Mailing Address
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Address Line | 4070 HENNEBERRY RD
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City | MANLIUS
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State | NY
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Zip | 13104-8532
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Country | US
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Telephone | 518-322-1320
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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 | 051292598
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 051292598
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 056558-1
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License Number State | NY
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