Waldron Stephenson Fortune

Primary specialty

PharmacistTaxonomy code 183500000X

License

C477847 Issued in CA

Practice address

2006 W Avenue J
Lancaster, CA 93536-5913

Phone

(661) 945-2729

Fax

(661) 949-7022

NPI assigned

Feb 8, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Garfield Beach CVS LLC

  • Pharmacy
  • Lancaster, CA
  • NPI 1497790307
  NPD (past)
• Garfield Beach CVS, L.L.C.

  • Pharmacy
  • Jurupa Valley, CA
  • NPI 1780573113
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549584000000",
    "number": "1760947253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2922 S BRONSON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900182836",
            "telephone_number": "323-717-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 W AVENUE J",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935365913",
            "telephone_number": "661-945-2729",
            "fax_number": "661-949-7022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTUNE",
        "first_name": "WALDRON",
        "middle_name": "STEPHENSON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-08",
        "last_updated": "2019-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "C47887",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "C477847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Fontenette
• Rose Forde
• Teresa Fordham-Jacobs
• Fort Medical Supplies, Inc.
• Fabio Fortunato, H.I.S.
• Daniel Foss, PT
• Ebony Darice Foster
• Megan Claire Foster
• Nicole Fowler, MSW, MPH
• Danielle Carene Frakes, ABAT

• Pharmacist in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.