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General NPI Number Information
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NPI Number | 1154625986
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Entity Type | Individual
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Provider Name | JACK JEFFREY WARD PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/09/2011
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Last Update Date | 01/09/2011
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Provider Practice Location Address
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Address Line | 1425 E CENTER ST
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City | KINGSPORT
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State | TN
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Zip | 37664-2501
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Country | US
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Telephone | 423-245-2181
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 EASTBROOK DR
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City | KINGSPORT
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State | TN
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Zip | 37663-2407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 34420
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License Number State | TN
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