Active NPI
Glenn Fortin, RPH
- Pharmacist
- Hanover, MA
National Provider Identifier
1073792099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 21965
- Practice address
- 35 Columbia Rd
Hanover, MA 02339-2317 - Phone
- (781) 499-4003
- Fax
- (781) 499-4006
- NPI assigned
- Oct 26, 2007
- Last updated
- Oct 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 21965 | MA | Primary |
Addresses
Primary practice location
35 Columbia Rd
Hanover, MA 02339-2317
Mailing address
12 Foster Ave
Marshfield, MA 02050-3813
Phone (781) 499-4003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21965 | MA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shaws Supermarkets Inc | Past | Accepting new patients | |
| Shaws Supermarkets Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193356800000",
"number": "1073792099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 FOSTER AVE",
"city": "MARSHFIELD",
"state": "MA",
"postal_code": "020503813",
"telephone_number": "781-499-4003",
"fax_number": "781-499-4006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 COLUMBIA RD",
"city": "HANOVER",
"state": "MA",
"postal_code": "023392317",
"telephone_number": "781-499-4003",
"fax_number": "781-499-4006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTIN",
"first_name": "GLENN",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-26",
"last_updated": "2007-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "21965",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hanover, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.