Provider Demographics
NPI:1063534980
Name:FORTON, WILLIAM JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:FORTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2130
Mailing Address - Country:US
Mailing Address - Phone:307-335-7568
Mailing Address - Fax:
Practice Address - Street 1:1733 N FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-5201
Practice Address - Country:US
Practice Address - Phone:307-857-3269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY2826OtherWYOMING PHARMACIST LIC.