Provider Demographics
NPI:1831585694
Name:POULAIN, RORY D (RPH)
Entity type:Individual
Prefix:MR
First Name:RORY
Middle Name:D
Last Name:POULAIN
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 1:3200 PLAZA EAST DR
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1607
Mailing Address - Country:US
Mailing Address - Phone:620-663-7628
Mailing Address - Fax:620-665-2647
Practice Address - Street 1:3200 PLAZA EAST DR
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1607
Practice Address - Country:US
Practice Address - Phone:620-663-7628
Practice Address - Fax:620-665-2647
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS19897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist