Provider Demographics
NPI:1467740332
Name:DIFFENBAUGH, MEGAN FONTANA (PHARMD, BCACP)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:FONTANA
Last Name:DIFFENBAUGH
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E LEE AVE
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-8132
Mailing Address - Country:US
Mailing Address - Phone:336-679-2661
Mailing Address - Fax:336-679-7056
Practice Address - Street 1:305 E LEE AVE
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8132
Practice Address - Country:US
Practice Address - Phone:336-679-2661
Practice Address - Fax:336-679-7056
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist