Provider Demographics
NPI:1225353634
Name:WARD, RICHARD C (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:WARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740
Mailing Address - Country:US
Mailing Address - Phone:631-261-2233
Mailing Address - Fax:631-261-0705
Practice Address - Street 1:51 BROADWAY
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1322
Practice Address - Country:US
Practice Address - Phone:631-261-2233
Practice Address - Fax:631-261-0705
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00684666Medicaid