Healthcare Provider Details

I. General information

NPI: 1104823988
Provider Name (Legal Business Name): FORTUNATO ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 BALTIMORE PIKE
SPRINGFIELD PA
19064-2850
US

IV. Provider business mailing address

1154 BALTIMORE PIKE
SPRINGFIELD PA
19064-2850
US

V. Phone/Fax

Practice location:
  • Phone: 610-544-4645
  • Fax: 610-544-1757
Mailing address:
  • Phone: 610-544-4645
  • Fax: 610-544-1757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP413223L
License Number StatePA

VIII. Authorized Official

Name: SHARON FORTUNATO
Title or Position: OWNER
Credential:
Phone: 610-544-4645