Provider Demographics
NPI:1396012993
Name:FONTANEZ, JUAN JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:FONTANEZ
Suffix:JR
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 1:45 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3301
Mailing Address - Country:US
Mailing Address - Phone:401-765-5040
Mailing Address - Fax:401-765-4840
Practice Address - Street 1:45 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3301
Practice Address - Country:US
Practice Address - Phone:401-765-5040
Practice Address - Fax:401-765-4840
Is Sole Proprietor?:No
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist