Provider Demographics
NPI:1023181096
Name:WARD, ROBERT PATRICK (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PATRICK
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 1:8 S PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-2448
Mailing Address - Country:US
Mailing Address - Phone:706-283-1412
Mailing Address - Fax:706-283-5144
Practice Address - Street 1:8 S PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-2448
Practice Address - Country:US
Practice Address - Phone:706-283-1412
Practice Address - Fax:706-283-5144
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA10996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00037991BMedicaid
GA00037991AMedicaid
GA1109746OtherNABP NUMBER
GA1109746OtherNABP NUMBER