Provider Demographics
NPI:1871034264
Name:FORTIN, CASSIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:FORTIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WATERVILLE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4900
Mailing Address - Country:US
Mailing Address - Phone:207-877-9161
Mailing Address - Fax:207-861-9529
Practice Address - Street 1:80 WATERVILLE COMMONS DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4900
Practice Address - Country:US
Practice Address - Phone:207-877-9161
Practice Address - Fax:207-861-9529
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist