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General NPI Number Information
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NPI Number | 1518603877
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Entity Type | Individual
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Provider Name | DR. LAURA ASHLEY FORNES
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Gender | Female
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 2 GREENO RD S
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City | FAIRHOPE
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State | AL
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Zip | 36532-2048
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Country | US
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Telephone | 251-928-6558
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Fax |
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Provider Business Mailing Address
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Address Line | 245 ROYAL LN
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City | FAIRHOPE
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State | AL
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Zip | 36532-4223
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Country | US
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Telephone | 251-423-5952
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17578
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License Number State | AL
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