Provider Demographics
NPI:1235452699
Name:FORTIER, DANIEL T (PHARM D)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:FORTIER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-6300
Mailing Address - Country:US
Mailing Address - Phone:518-289-5997
Mailing Address - Fax:
Practice Address - Street 1:521 DUANESBURG RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-1054
Practice Address - Country:US
Practice Address - Phone:518-356-2968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist