MEDICARE: DR. TODD ALAN FORTNEY PHARMD, RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP440135	PA

General Provider Information

NPI Number	:	1124016811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD ALAN FORTNEY PHARMD, RPH

Provider Business Mailing Address
First Line	:	2300 MACLAY AVE
Second Line	:
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-2636
Country	:	US
Telephone Number	:	814-644-1631
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MACLAY AVE
Second Line	:
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-2636
Country	:	US
Telephone Number	:	814-643-8602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	10/04/2019

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