Provider Demographics
NPI:1083020200
Name:MOUTON, RYAN PHILLIP (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PHILLIP
Last Name:MOUTON
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 1:2150 PENNSYLVANIA AVE NW STE G-201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-2218
Mailing Address - Fax:202-741-3621
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW FL 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2222
Practice Address - Fax:202-741-2185
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22389183500000X
VA0202212951183500000X
DCPH100001742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist