Provider Demographics
NPI:1184901845
Name:FORNATARO, JEANNETTE J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:J
Last Name:FORNATARO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JEANNETTE
Other - Middle Name:J
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2800 INDEPENDENCE DR
Mailing Address - Street 2:W146
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7628
Mailing Address - Country:US
Mailing Address - Phone:925-443-6783
Mailing Address - Fax:
Practice Address - Street 1:2800 INDEPENDENCE DR
Practice Address - Street 2:W146
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-7628
Practice Address - Country:US
Practice Address - Phone:925-443-6783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist