Healthcare Provider Details

I. General information

NPI: 1164834867
Provider Name (Legal Business Name): WARD SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3646 SUNSET AVE SUITE 110 BARKLEY SQUARE
ROCKY MOUNT NC
27804
US

IV. Provider business mailing address

PO BOX 8573
ROCKY MOUNT NC
27804-1573
US

V. Phone/Fax

Practice location:
  • Phone: 252-459-5544
  • Fax:
Mailing address:
  • Phone: 252-459-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number11998
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number11998
License Number StateNC

VIII. Authorized Official

Name: MR. PATRICK MONTE IGNACIO
Title or Position: PHARMACIST MANAGER
Credential: PHARMACIST
Phone: 252-459-5544