Provider Demographics
NPI:1962948836
Name:WARD, PHILLIP T
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:T
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COLUMBUS CORNERS DR
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-4905
Mailing Address - Country:US
Mailing Address - Phone:910-640-1893
Mailing Address - Fax:910-640-2958
Practice Address - Street 1:200 COLUMBUS CORNERS DR
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4905
Practice Address - Country:US
Practice Address - Phone:910-640-1893
Practice Address - Fax:910-640-2958
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist