Provider Demographics
NPI:1134831449
Name:FORTUNE, ANGELA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DIAMOND AVE UNIT 9
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2987
Mailing Address - Country:US
Mailing Address - Phone:860-751-9272
Mailing Address - Fax:
Practice Address - Street 1:597 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3947
Practice Address - Country:US
Practice Address - Phone:860-582-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist