Provider Demographics
NPI:1245971423
Name:WARE, WILLIAM ETHAN (CPHT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ETHAN
Last Name:WARE
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:TUNNEL HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30755-9385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721
Practice Address - Country:US
Practice Address - Phone:706-272-9346
Practice Address - Fax:706-272-9372
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC045378183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician