Provider Demographics
NPI:1497040653
Name:WARD, JOHN MITCHELL (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MITCHELL
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 1:100 WOMANS WAY STE SSB1
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5100
Mailing Address - Country:US
Mailing Address - Phone:225-924-8199
Mailing Address - Fax:225-928-8844
Practice Address - Street 1:2001 MILLERVILLE RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1408
Practice Address - Country:US
Practice Address - Phone:225-275-2109
Practice Address - Fax:225-275-2109
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2204823Medicaid