Provider Demographics
NPI:1205297561
Name:PATRICK, RYAN LOWRY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LOWRY
Last Name:PATRICK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:VA
Mailing Address - Zip Code:24283-0980
Mailing Address - Country:US
Mailing Address - Phone:276-762-5011
Mailing Address - Fax:
Practice Address - Street 1:16435 WISE STREET
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:VA
Practice Address - Zip Code:24283
Practice Address - Country:US
Practice Address - Phone:276-762-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist