Provider Demographics
NPI:1497588412
Name:FORTE, ANDREW (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name: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 1:4339 ALUMROOT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8003
Mailing Address - Country:US
Mailing Address - Phone:260-450-6603
Mailing Address - Fax:
Practice Address - Street 1:929 S 13TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-1805
Practice Address - Country:US
Practice Address - Phone:260-724-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030973A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist