Healthcare Provider Details

I. General information

NPI: 1063752780
Provider Name (Legal Business Name): MARGRETTE FORTUNE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S GADSDEN ST
TALLAHASSEE FL
32301-5506
US

IV. Provider business mailing address

1720 S GADSDEN ST
TALLAHASSEE FL
32301-5506
US

V. Phone/Fax

Practice location:
  • Phone: 850-521-5120
  • Fax: 850-521-5108
Mailing address:
  • Phone: 850-521-5120
  • Fax: 850-521-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS24834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: