Provider Demographics
NPI:1821296401
Name:FORD, FOREST RAY JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:FOREST
Middle Name:RAY
Last Name:FORD
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21371
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89515-1371
Mailing Address - Country:US
Mailing Address - Phone:616-757-9662
Mailing Address - Fax:
Practice Address - Street 1:34 RESERVATION RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1521
Practice Address - Country:US
Practice Address - Phone:775-329-5162
Practice Address - Fax:775-789-5612
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0099201835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy