Provider Demographics
NPI:1295205177
Name:FORNISHI, YVONNE L (RPH)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:L
Last Name:FORNISHI
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 1:520 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-4539
Mailing Address - Country:US
Mailing Address - Phone:301-724-6100
Mailing Address - Fax:301-724-6108
Practice Address - Street 1:17703 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7850
Practice Address - Country:US
Practice Address - Phone:240-420-5310
Practice Address - Fax:240-420-5356
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist