Healthcare Provider Details

I. General information

NPI: 1821247784
Provider Name (Legal Business Name): JEFFERY ALAN WARD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CACTUS RD
GALLUP NM
87301-5774
US

IV. Provider business mailing address

205 CACTUS RD
GALLUP NM
87301-5774
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1185
  • Fax: 505-726-8621
Mailing address:
  • Phone: 505-722-1185
  • Fax: 505-726-8621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6155
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: