Provider Demographics
NPI:1992570659
Name:RAGAN, ROWAN
Entity type:Individual
Prefix:
First Name:ROWAN
Middle Name:
Last Name:RAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 ROSS AVE APT 1014
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5450
Mailing Address - Country:US
Mailing Address - Phone:225-400-5398
Mailing Address - Fax:
Practice Address - Street 1:108 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4444
Practice Address - Country:US
Practice Address - Phone:214-943-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist