Provider Demographics
NPI:1073052981
Name:SEALE, WARD KIRK (PHARMD)
Entity Type:Individual
Prefix:
First Name:WARD
Middle Name:KIRK
Last Name:SEALE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 NORTH BROWNELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801
Mailing Address - Country:US
Mailing Address - Phone:417-206-6165
Mailing Address - Fax:417-206-6165
Practice Address - Street 1:3302 N BROWNELL AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1444
Practice Address - Country:US
Practice Address - Phone:417-206-6165
Practice Address - Fax:417-206-6165
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004002896183500000X
ARPD10332183500000X
KS13387183500000X
MSE07497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist