Provider Demographics
NPI:1639461643
Name:WARD, RANDALL DEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:DEAN
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 1:4135 N GEORGE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-9208
Mailing Address - Country:US
Mailing Address - Phone:717-266-6609
Mailing Address - Fax:717-268-7164
Practice Address - Street 1:4135 N GEORGE STREET EXT
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-9208
Practice Address - Country:US
Practice Address - Phone:717-266-6609
Practice Address - Fax:717-268-7164
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist