Healthcare Provider Details

I. General information

NPI: 1710390075
Provider Name (Legal Business Name): TOM L WARE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 ALEXANDRIA PIKE
COLD SPRING KY
41076-2169
US

IV. Provider business mailing address

5400 ALEXANDRIA PIKE
COLD SPRING KY
41076-2169
US

V. Phone/Fax

Practice location:
  • Phone: 859-448-4210
  • Fax: 859-448-4265
Mailing address:
  • Phone: 859-448-4210
  • Fax: 859-448-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8749
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: