MEDICARE: DR. ESAN N FORDE PHARM.D, CGP, M.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835G0303X	Geriatric Pharmacist	57162	CA
2	183500000X	Pharmacist	PS43538	FL

General Provider Information

NPI Number	:	1134152101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ESAN N FORDE PHARM.D, CGP, M.S

Provider Business Mailing Address
First Line	:	6321 NW 179TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4450
Country	:	US
Telephone Number	:	626-399-3021
Fax Number	:

Provider Business Practice Location Address
First Line	:	6321 NW 179TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4450
Country	:	US
Telephone Number	:	626-399-3021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/29/2012

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