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NPI Code Detail

MEDICARE: DR. JAMES TREVOR DE FORTE PHARMD, RPH

MEDICARE: DR. JAMES TREVOR DE FORTE PHARMD, RPH
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
1183500000XPharmacist068145NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1068145OTHERNYNEW YORK STATE PHARMACY LICENSE NUMBER

General Provider Information

NPI Number : 1770217101
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES TREVOR DE FORTE PHARMD, RPH
Provider Business Mailing Address
First Line : 2045 FOREST AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10303-1734
Country : US
Telephone Number : 718-982-8019
Fax Number :
Provider Business Practice Location Address
First Line : 2045 FOREST AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10303-1734
Country : US
Telephone Number : 718-982-8019
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2022
Last Update Date : 07/12/2022

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