Healthcare Provider Details

I. General information

NPI: 1679097562
Provider Name (Legal Business Name): JOHN ANTHONY FORTE III PHARM D., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 SALEM RD
VIRGINIA BEACH VA
23456-1393
US

IV. Provider business mailing address

521 TROTTERS LN
CHESAPEAKE VA
23322-6956
US

V. Phone/Fax

Practice location:
  • Phone: 757-471-1053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202216026
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: