MEDICARE: MR. DONALD ARTHUR FORDHAM 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
1	183500000X	Pharmacist	RPH009133	GA

General Provider Information

NPI Number	:	1801194402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD ARTHUR FORDHAM RPH

Provider Business Mailing Address
First Line	:	165 RALEIGH RD
Second Line	:	P O BOX 546
City	:	WOODBURY
State	:	GA
Zip	:	30293-3806
Country	:	US
Telephone Number	:	706-846-2985
Fax Number	:

Provider Business Practice Location Address
First Line	:	3472 MACON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-2528
Country	:	US
Telephone Number	:	706-563-4992
Fax Number	:	706-568-4923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2011
Last Update Date	:	03/05/2011

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