Provider Demographics
NPI:1093352890
Name:LAFONTAINE, CARRIE MONIQUE (RPH)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MONIQUE
Last Name:LAFONTAINE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9968 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1924
Mailing Address - Country:US
Mailing Address - Phone:810-225-2275
Mailing Address - Fax:
Practice Address - Street 1:9968 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1924
Practice Address - Country:US
Practice Address - Phone:810-225-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist