Provider Demographics
NPI:1780018093
Name:FORD, PATRICK DAVID
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DAVID
Last Name:FORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 NISSAN DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4447
Mailing Address - Country:US
Mailing Address - Phone:615-355-7546
Mailing Address - Fax:
Practice Address - Street 1:806 NISSAN DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4447
Practice Address - Country:US
Practice Address - Phone:615-355-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician