Provider Demographics
NPI:1750830212
Name:KINDULAS, RYAN (PH60667638)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KINDULAS
Suffix:
Gender:M
Credentials:PH60667638
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 MCNEIL ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9779
Mailing Address - Country:US
Mailing Address - Phone:203-598-1876
Mailing Address - Fax:
Practice Address - Street 1:8333 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5808
Practice Address - Country:US
Practice Address - Phone:360-455-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60667638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist