Individual
DR. RYAN FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH
Contact information
Practice address
1028 WISCONSIN AVE, BOSCOBEL, WI 53805-1532
(703) 606-1417
Mailing address
1028 WISCONSIN AVE, BOSCOBEL, WI 53805-1532
(703) 606-1417
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
19763-40
WI
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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