Provider Demographics
NPI:1013465335
Name:FORTUNE, ZEB MCRAE (PHARM D)
Entity Type:Individual
Prefix:
First Name:ZEB
Middle Name:MCRAE
Last Name:FORTUNE
Suffix:
Gender:M
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 1:1225 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3317
Mailing Address - Country:US
Mailing Address - Phone:518-458-8691
Mailing Address - Fax:
Practice Address - Street 1:1225 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3317
Practice Address - Country:US
Practice Address - Phone:518-458-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist