Provider Demographics
NPI:1124463138
Name:FORBES, VITTELIAN (RPH)
Entity type:Individual
Prefix:
First Name:VITTELIAN
Middle Name:
Last Name:FORBES
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 1:7020 E MORELAND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3318
Mailing Address - Country:US
Mailing Address - Phone:480-329-9585
Mailing Address - Fax:
Practice Address - Street 1:1701 E THOMAS RD STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7672
Practice Address - Country:US
Practice Address - Phone:602-237-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist