Provider Demographics
NPI:1578521134
Name:FORTNER, CHARLES R (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:FORTNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 S LIMERICK DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9234
Mailing Address - Country:US
Mailing Address - Phone:509-489-4500
Mailing Address - Fax:509-489-4527
Practice Address - Street 1:1806 S LIMERICK DR
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-9234
Practice Address - Country:US
Practice Address - Phone:509-489-4500
Practice Address - Fax:509-489-4527
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000111071835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy