Provider Demographics
NPI:1518603877
Name:FORNES, LAURA ASHLEY
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ASHLEY
Last Name:FORNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 ROYAL LN
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-4223
Mailing Address - Country:US
Mailing Address - Phone:251-423-5952
Mailing Address - Fax:
Practice Address - Street 1:2 GREENO RD S
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2048
Practice Address - Country:US
Practice Address - Phone:251-928-6558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL17578Medicaid