Provider Demographics
NPI:1679178172
Name:COULTER, RYAN WEST (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WEST
Last Name:COULTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:WEST
Other - Last Name:COULTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6120 HICKORY FLAT HWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7252
Mailing Address - Country:US
Mailing Address - Phone:770-720-0610
Mailing Address - Fax:
Practice Address - Street 1:6120 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-7252
Practice Address - Country:US
Practice Address - Phone:770-720-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist