Provider Demographics
NPI:1407226566
Name:WARE, KENRIC BENJAMIN
Entity Type:Individual
Prefix:
First Name:KENRIC
Middle Name:BENJAMIN
Last Name:WARE
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 1:1000 WINDSOR SHORES DR
Mailing Address - Street 2:APT 27A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1717
Mailing Address - Country:US
Mailing Address - Phone:803-935-9695
Mailing Address - Fax:803-935-4564
Practice Address - Street 1:10 SCIENCE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9344
Practice Address - Country:US
Practice Address - Phone:803-935-9695
Practice Address - Fax:803-935-4564
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025716183500000X
SC14031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist