Provider Demographics
NPI:1003708728
Name:WARD, JACOB RYAN (RPH)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:RYAN
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 1:8058 MERRIMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-3124
Mailing Address - Country:US
Mailing Address - Phone:727-698-6938
Mailing Address - Fax:
Practice Address - Street 1:10801 STARKEY RD STE 200
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-1161
Practice Address - Country:US
Practice Address - Phone:727-397-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS69102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist