Provider Demographics
NPI:1275863409
Name:FUENTES, CHAD (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:FUENTES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S MILL AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2128
Mailing Address - Country:US
Mailing Address - Phone:480-921-8013
Mailing Address - Fax:480-921-7219
Practice Address - Street 1:2000 S MILL AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2128
Practice Address - Country:US
Practice Address - Phone:480-921-8013
Practice Address - Fax:480-921-7219
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist