Provider Demographics
NPI:1588821854
Name:FORTINO-POMPA, LUISA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LUISA
Middle Name:
Last Name:FORTINO-POMPA
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 1:464 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3645
Mailing Address - Country:US
Mailing Address - Phone:914-967-0856
Mailing Address - Fax:914-967-1989
Practice Address - Street 1:464 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-3645
Practice Address - Country:US
Practice Address - Phone:914-967-0856
Practice Address - Fax:914-967-1989
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist