Provider Demographics
NPI:1184986812
Name:RUARK, DAVID NEALE (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NEALE
Last Name:RUARK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 SE 192ND AVE
Mailing Address - Street 2:C/O PHARMACY
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-253-3043
Mailing Address - Fax:360-253-3031
Practice Address - Street 1:3505 SE 192ND AVE
Practice Address - Street 2:C/O PHARMACY
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1436
Practice Address - Country:US
Practice Address - Phone:360-253-3043
Practice Address - Fax:360-253-3031
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000221941835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1134144777Medicaid