Provider Demographics
NPI:1730791062
Name:WARE, NYLVIA (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:NYLVIA
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4523 IVY PATCH DR
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-6964
Mailing Address - Country:US
Mailing Address - Phone:706-987-2012
Mailing Address - Fax:
Practice Address - Street 1:3702 2ND AVE STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7408
Practice Address - Country:US
Practice Address - Phone:706-507-9209
Practice Address - Fax:706-786-0747
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20932183500000X
GARPH034868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist