Provider Demographics
NPI:1578579306
Name:WARE'S PHARMACY LLC
Entity Type:Organization
Organization Name:WARE'S PHARMACY LLC
Other - Org Name:WARE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-676-9199
Mailing Address - Street 1:304 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1652
Mailing Address - Country:US
Mailing Address - Phone:517-676-9199
Mailing Address - Fax:517-676-9165
Practice Address - Street 1:304 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1652
Practice Address - Country:US
Practice Address - Phone:517-676-9199
Practice Address - Fax:517-676-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010013143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170353OtherPK
MI1551413Medicaid