Provider Demographics
NPI:1174523484
Name:FORD, RENEE MICHELLE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MICHELLE
Last Name:FORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:MICHELLE
Other - Last Name:CHEVALIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:21 COUNTRY WAY
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1652
Mailing Address - Country:US
Mailing Address - Phone:207-989-1253
Mailing Address - Fax:
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-6654
Practice Address - Fax:207-973-4781
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME43041835P1200X
RI33281835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy