Provider Demographics
NPI:1124393491
Name:FORTNER, KRISTI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:FORTNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18805 STATE ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1438
Mailing Address - Country:US
Mailing Address - Phone:360-805-8133
Mailing Address - Fax:
Practice Address - Street 1:18805 STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1438
Practice Address - Country:US
Practice Address - Phone:360-805-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60021995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist