Provider Demographics
NPI:1396113155
Name:WARD, JENNIFER WAITS (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WAITS
Last Name:WARD
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 1:10444 N MALL DR
Mailing Address - Street 2:PHARMACY
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-4835
Mailing Address - Country:US
Mailing Address - Phone:225-295-0914
Mailing Address - Fax:225-295-9587
Practice Address - Street 1:10444 N MALL DR
Practice Address - Street 2:PHARMACY
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4835
Practice Address - Country:US
Practice Address - Phone:225-295-0914
Practice Address - Fax:225-295-9587
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist