Provider Demographics
NPI:1972871895
Name:WARE ALEXANDER, TIAWANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIAWANA
Middle Name:
Last Name:WARE ALEXANDER
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 1:3445 TERRY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-4956
Mailing Address - Country:US
Mailing Address - Phone:601-372-8750
Mailing Address - Fax:601-372-3833
Practice Address - Street 1:3445 TERRY RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-4956
Practice Address - Country:US
Practice Address - Phone:601-372-8750
Practice Address - Fax:601-372-3833
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-0106081835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy