Provider Demographics
NPI:1720611791
Name:FORT, PATIENCE NAVE (RPH)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:NAVE
Last Name:FORT
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 1:607 FOUR WINDS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-1475
Mailing Address - Country:US
Mailing Address - Phone:859-626-7092
Mailing Address - Fax:
Practice Address - Street 1:CHANDLER RETAIL PHARMACY 1000 S LIMESTONE ROOM A.01.114
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-218-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist