Provider Demographics
NPI:1679560882
Name:OFTEBRO, RYAN DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:OFTEBRO
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 1:616 OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1717
Mailing Address - Country:US
Mailing Address - Phone:206-622-3565
Mailing Address - Fax:206-382-9727
Practice Address - Street 1:616 OLIVE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1717
Practice Address - Country:US
Practice Address - Phone:206-622-3565
Practice Address - Fax:206-382-9727
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00052708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist