Provider Demographics
NPI:1083346795
Name:WARREN, IAN PATRICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:PATRICK
Last Name:WARREN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9414 N DIVISION ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1278
Mailing Address - Country:US
Mailing Address - Phone:509-467-6806
Mailing Address - Fax:509-468-8725
Practice Address - Street 1:9414 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1229
Practice Address - Country:US
Practice Address - Phone:509-467-6806
Practice Address - Fax:509-468-8725
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist