Provider Demographics
NPI:1023368354
Name:FONTES, JAMES E (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:FONTES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1819
Mailing Address - Country:US
Mailing Address - Phone:401-278-4901
Mailing Address - Fax:401-278-4907
Practice Address - Street 1:1140 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1819
Practice Address - Country:US
Practice Address - Phone:401-278-4901
Practice Address - Fax:401-278-4907
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05122183500000X
MAPH234186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist