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General NPI Number Information
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NPI Number | 1619441490
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Entity Type | Individual
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Provider Name | JORDAN WARE
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Gender | Male
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 711 12TH ST
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City | ASHLAND
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State | KY
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Zip | 41101-2668
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Country | US
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Telephone | 606-325-8231
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Fax |
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Provider Business Mailing Address
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Address Line | 3716 BRIARWOOD DR
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City | CATLETTSBURG
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State | KY
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Zip | 41129-9299
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Country | US
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Telephone | 606-922-9263
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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 | 020306
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License Number State | KY
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