Provider Demographics
NPI:1568429736
Name:FAGUNDES, ALFRED MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:MICHAEL
Last Name:FAGUNDES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PINE VIEW CT
Mailing Address - Street 2:P.O. BOX 2123
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-9167
Mailing Address - Country:US
Mailing Address - Phone:707-464-8449
Mailing Address - Fax:
Practice Address - Street 1:475 M ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-4129
Practice Address - Country:US
Practice Address - Phone:707-465-3663
Practice Address - Fax:707-464-8533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24038183500000X
OR9086183500000X
HI2111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist