Provider Demographics
NPI:1851871271
Name:QUALE, RYAN JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:QUALE
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 1:6432 W DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9229
Mailing Address - Country:US
Mailing Address - Phone:208-731-7434
Mailing Address - Fax:
Practice Address - Street 1:911 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8608
Practice Address - Country:US
Practice Address - Phone:208-788-6709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP8024OtherBOARD OF PHARMACY