Provider Demographics
NPI:1649029703
Name:FORTUGNO, MARC (PHARMD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:FORTUGNO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23625 HOLMAN HWY
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5902
Mailing Address - Country:US
Mailing Address - Phone:831-624-5311
Mailing Address - Fax:
Practice Address - Street 1:23625 HOLMAN HWY
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5902
Practice Address - Country:US
Practice Address - Phone:831-624-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA811941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist