Provider Demographics
NPI:1417051582
Name:WARD, EARL DAVID JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:DAVID
Last Name:WARD
Suffix:JR
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:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:TOWAOC
Mailing Address - State:CO
Mailing Address - Zip Code:81334-0049
Mailing Address - Country:US
Mailing Address - Phone:970-565-4441
Mailing Address - Fax:
Practice Address - Street 1:232 RUSTLING WILLOW ST
Practice Address - Street 2:
Practice Address - City:TOWAOC
Practice Address - State:CO
Practice Address - Zip Code:81334-0049
Practice Address - Country:US
Practice Address - Phone:970-565-4441
Practice Address - Fax:970-565-4945
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS111115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist