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General NPI Number Information
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NPI Number | 1962842369
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Entity Type | Individual
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Provider Name | RICHARD ERNEST FORTUNATO DR.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 15200 E COLFAX AVE
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City | AURORA
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State | CO
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Zip | 80011-6965
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Country | US
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Telephone | 720-988-3755
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Fax | 303-344-2386
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Provider Business Mailing Address
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Address Line | PO BOX 984
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City | NEDERLAND
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State | CO
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Zip | 80466-0984
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Country | US
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Telephone | 720-988-3755
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Fax | 303-344-2386
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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 | 15806
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License Number State | CO
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