Provider Demographics
NPI:1396966685
Name:FORDHAM, PEGGY BRENNAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:BRENNAN
Last Name:FORDHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 SHARBER ROAD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817
Mailing Address - Country:US
Mailing Address - Phone:229-246-4827
Mailing Address - Fax:
Practice Address - Street 1:1500 SHUTWELL STREET
Practice Address - Street 2:BAINBRIDGE MEMORIAL HOSPITAL
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817
Practice Address - Country:US
Practice Address - Phone:229-243-6163
Practice Address - Fax:229-243-3327
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist