Provider Demographics
NPI:1043932775
Name:BOUSQUET, RYAN GEORGE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:GEORGE
Last Name:BOUSQUET
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 1:22 MARTINS WAY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1304
Mailing Address - Country:US
Mailing Address - Phone:401-477-9052
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST # D
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MA
Practice Address - Zip Code:02330-1089
Practice Address - Country:US
Practice Address - Phone:401-477-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist