Provider Demographics
NPI:1760704936
Name:FORTUNATO, JENNIFER (PHARM D , RPH)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:PHARM D , RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4306
Mailing Address - Country:US
Mailing Address - Phone:303-252-9150
Mailing Address - Fax:303-450-2573
Practice Address - Street 1:1400 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4306
Practice Address - Country:US
Practice Address - Phone:303-252-9150
Practice Address - Fax:303-450-2573
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16818OtherCOLORADO BOARD OF PHARMACY LICENSE