Provider Demographics
NPI:1972741916
Name:BARTHOLOMEW, RALPH (R PH)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:R PH
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 816
Mailing Address - Street 2:1020 CRANDALL DR
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-0816
Mailing Address - Country:US
Mailing Address - Phone:307-254-2516
Mailing Address - Fax:
Practice Address - Street 1:1020 CRANDALL DR
Practice Address - Street 2:BOX 816
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-4537
Practice Address - Country:US
Practice Address - Phone:307-254-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist