Provider Demographics
NPI:1619268927
Name:WARD, ALICIA MONTGOMERY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MONTGOMERY
Last Name:WARD
Suffix:
Gender:F
Credentials:PHARMD
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 16
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-0016
Mailing Address - Country:US
Mailing Address - Phone:606-349-1535
Mailing Address - Fax:
Practice Address - Street 1:308 PARKWAY DRIVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465
Practice Address - Country:US
Practice Address - Phone:606-349-1044
Practice Address - Fax:606-349-7799
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist