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General NPI Number Information
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NPI Number | 1073792099
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Entity Type | Individual
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Provider Name | GLENN FORTIN RPH
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Gender | Male
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 35 COLUMBIA RD
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City | HANOVER
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State | MA
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Zip | 02339-2317
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Country | US
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Telephone | 781-499-4003
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Fax | 781-499-4006
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Provider Business Mailing Address
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Address Line | 12 FOSTER AVE
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City | MARSHFIELD
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State | MA
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Zip | 02050-3813
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Country | US
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Telephone | 781-499-4003
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Fax | 781-499-4006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21965
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License Number State | MA
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