Provider Demographics
NPI:1124016811
Name:FORTNEY, TODD ALAN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALAN
Last Name:FORTNEY
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MACLAY AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2636
Mailing Address - Country:US
Mailing Address - Phone:814-644-1631
Mailing Address - Fax:
Practice Address - Street 1:2300 MACLAY AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2636
Practice Address - Country:US
Practice Address - Phone:814-643-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist