Healthcare Provider Details

I. General information

NPI: 1821296401
Provider Name (Legal Business Name): FOREST RAY FORD JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 RESERVATION RD
RENO NV
89502-1521
US

IV. Provider business mailing address

PO BOX 21371
RENO NV
89515-1371
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-5162
  • Fax: 775-789-5612
Mailing address:
  • Phone: 616-757-9662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number009920
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: