Provider Demographics
NPI:1558771097
Name:WARD, CAMMY
Entity Type:Individual
Prefix:
First Name:CAMMY
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CARMELA
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:242 BACK CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-4729
Mailing Address - Country:US
Mailing Address - Phone:317-408-5431
Mailing Address - Fax:317-885-3065
Practice Address - Street 1:150 S MARLIN DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1451
Practice Address - Country:US
Practice Address - Phone:317-885-3010
Practice Address - Fax:317-885-3065
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26016363OtherPHARMACY LICENSE