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NPI Code Detail

MEDICARE: ROY BENJAMIN FORNWALT II PHARM.D.,R.PH.

MEDICARE: ROY BENJAMIN FORNWALT II PHARM.D.,R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03132257OH

General Provider Information

NPI Number : 1285039867
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROY BENJAMIN FORNWALT II PHARM.D.,R.PH.
Provider Business Mailing Address
First Line : 20405 CHAGRIN BLVD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-5324
Country : US
Telephone Number : 216-752-4866
Fax Number :
Provider Business Practice Location Address
First Line : 20405 CHAGRIN BLVD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-5324
Country : US
Telephone Number : 216-752-4866
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2014
Last Update Date : 10/25/2014

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