Provider Demographics
NPI:1770217101
Name:DE FORTE, JAMES TREVOR (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TREVOR
Last Name:DE FORTE
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1734
Mailing Address - Country:US
Mailing Address - Phone:718-982-8019
Mailing Address - Fax:
Practice Address - Street 1:2045 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1734
Practice Address - Country:US
Practice Address - Phone:718-982-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY068145OtherNEW YORK STATE PHARMACY LICENSE NUMBER