Provider Demographics
NPI:1558640656
Name:FUENTES, DAVID G JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:FUENTES
Suffix:JR
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 1:1400 N ROOSEVELT BLVD
Mailing Address - Street 2:245
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4377
Mailing Address - Country:US
Mailing Address - Phone:847-330-4540
Mailing Address - Fax:
Practice Address - Street 1:1400 N ROOSEVELT BLVD
Practice Address - Street 2:245
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4377
Practice Address - Country:US
Practice Address - Phone:847-330-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555201835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric