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General NPI Number Information
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NPI Number | 1861468472
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Entity Type | Individual
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Provider Name | LARRY T FORTENBERRY RPH
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Gender | Male
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 95 WEDDINGTON BRANCH RD
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City | PIKEVILLE
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State | KY
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Zip | 41501-3203
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Country | US
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Telephone | 606-432-2424
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 734
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City | PIKEVILLE
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State | KY
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Zip | 41502-0734
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Country | US
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Telephone | 606-432-6860
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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 | 10701
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License Number State | KY
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