Organization
FORTUNA PHARMACY INC
Active
Other names
GREEN'S FORTUNA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT EARL JOHNSON RPH (PRESIDENT)
(707) 725-4431
Entity
Organization
Contact information
Practice address
1058 MAIN ST, FORTUNA, CA 95540-2009
(707) 725-4431
(707) 725-2671
Mailing address
1058 MAIN ST, FORTUNA, CA 95540-2009
(707) 725-4431
(707) 725-2671
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY37268
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA372680
—
CA
Enumeration date
05/04/2007
Last updated
08/22/2020
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