Provider Demographics
NPI:1477200095
Name:FORTUNE, KRISTY NOEL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:NOEL
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 DAVIS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2086
Mailing Address - Country:US
Mailing Address - Phone:765-432-8058
Mailing Address - Fax:
Practice Address - Street 1:107 CHARLES E DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2745
Practice Address - Country:US
Practice Address - Phone:615-346-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist