Provider Demographics
NPI:1467862110
Name:FORTNER, KATHERINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
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 1:28717 GRUMMAN DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9542
Mailing Address - Country:US
Mailing Address - Phone:800-982-2730
Mailing Address - Fax:
Practice Address - Street 1:28717 GRUMMAN DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-9542
Practice Address - Country:US
Practice Address - Phone:800-330-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-04
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00118831835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric