Provider Demographics
NPI:1134486103
Name:ERLEWINE, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ERLEWINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 NW GRASS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-4001
Mailing Address - Country:US
Mailing Address - Phone:509-969-5175
Mailing Address - Fax:
Practice Address - Street 1:3210 NW GRASS VALLEY DR
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-4001
Practice Address - Country:US
Practice Address - Phone:509-969-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60021512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist