Healthcare Provider Details

I. General information

NPI: 1407226566
Provider Name (Legal Business Name): KENRIC BENJAMIN WARE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SCIENCE CT
COLUMBIA SC
29203-9344
US

IV. Provider business mailing address

1000 WINDSOR SHORES DR APT 27A
COLUMBIA SC
29223-1717
US

V. Phone/Fax

Practice location:
  • Phone: 803-935-9695
  • Fax: 803-935-4564
Mailing address:
  • Phone: 803-935-9695
  • Fax: 803-935-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025716
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14031
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: