Provider Demographics
NPI:1114136975
Name:WARD, JEFF K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:K
Last Name:WARD
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 1:216 AVENIDA MELISENDA
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3952
Mailing Address - Country:US
Mailing Address - Phone:909-305-1306
Mailing Address - Fax:909-599-8873
Practice Address - Street 1:216 AVENIDA MELISENDA
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773
Practice Address - Country:US
Practice Address - Phone:909-305-1306
Practice Address - Fax:909-599-8873
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist