Healthcare Provider Details

I. General information

NPI: 1174523484
Provider Name (Legal Business Name): RENEE MICHELLE FORD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE MICHELLE CHEVALIER BS

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 STATE ST
BANGOR ME
04401-6616
US

IV. Provider business mailing address

21 COUNTRY WAY
BREWER ME
04412-1652
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-6654
  • Fax: 207-973-4781
Mailing address:
  • Phone: 207-989-1253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number4304
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3328
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: