Provider Demographics
NPI:1386836500
Name:WARTHEN, ALI T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:T
Last Name:WARTHEN
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 1:3028 W GINGER CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4560
Mailing Address - Country:US
Mailing Address - Phone:904-226-1321
Mailing Address - Fax:
Practice Address - Street 1:3028 W GINGER CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-4560
Practice Address - Country:US
Practice Address - Phone:904-226-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36214261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center