Provider Demographics
NPI:1285235184
Name:FORTIN, DONNA (PHARMD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:FORTIN
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 1:50 JOANNE DR
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2007
Mailing Address - Country:US
Mailing Address - Phone:603-318-5660
Mailing Address - Fax:
Practice Address - Street 1:79 BICENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-1306
Practice Address - Country:US
Practice Address - Phone:603-644-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3403OtherNH BOARD OF PHARMACY