Individual
RYAN JAMES QUALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
911 N MAIN ST, HAILEY, ID 83333-8608
(208) 788-6709
Mailing address
6432 W DOUGLAS ST, BOISE, ID 83704-9229
(208) 731-7434
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8024
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P8024
BOARD OF PHARMACY
ID
Enumeration date
08/15/2018
Last updated
08/15/2018
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