Provider Demographics
NPI:1871915215
Name:WARE, ROY (RPH)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:
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 1:3450 N GLASSFORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1351
Mailing Address - Country:US
Mailing Address - Phone:928-499-3478
Mailing Address - Fax:928-499-3147
Practice Address - Street 1:3450 N GLASSFORD HILL RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1351
Practice Address - Country:US
Practice Address - Phone:928-499-3478
Practice Address - Fax:928-499-3147
Is Sole Proprietor?:No
Enumeration Date:2014-01-18
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist