Provider Demographics
NPI:1801388921
Name:WARE, DAN THOMAS (RPH)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:THOMAS
Last Name:WARE
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 1:1866 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAYNESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71038-4904
Mailing Address - Country:US
Mailing Address - Phone:318-624-1053
Mailing Address - Fax:318-624-2233
Practice Address - Street 1:1866 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAYNESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71038-4904
Practice Address - Country:US
Practice Address - Phone:318-624-1053
Practice Address - Fax:318-624-2233
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist