=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245602408
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA GLADNEY WARD RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2015
-----------------------------------------------------
Last Update Date | 10/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2630 WILLARD DAIRY RD
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27265-8351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-884-3838
-----------------------------------------------------
Fax | 336-884-3840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2630 WILLARD DAIRY RD
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27265-8351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-884-3838
-----------------------------------------------------
Fax | 336-884-3840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 14702
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------