MEDICARE: TIAWANA WARE ALEXANDER PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	E-010608	MS

General Provider Information

NPI Number	:	1972871895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIAWANA WARE ALEXANDER PHARM.D.

Provider Business Mailing Address
First Line	:	3445 TERRY RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-4956
Country	:	US
Telephone Number	:	601-372-8750
Fax Number	:	601-372-3833

Provider Business Practice Location Address
First Line	:	3445 TERRY RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-4956
Country	:	US
Telephone Number	:	601-372-8750
Fax Number	:	601-372-3833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	12/22/2017

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