Provider Demographics
NPI:1437423050
Name:THOMAS, RYAN S
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:S
Last Name:THOMAS
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 1:200 S 1ST ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2386
Mailing Address - Country:US
Mailing Address - Phone:541-567-6850
Mailing Address - Fax:
Practice Address - Street 1:200 S 1ST ST UNIT 1
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2386
Practice Address - Country:US
Practice Address - Phone:541-567-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0012723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH0012723OtherSTATE PHARMACIST LICENSE