Provider Demographics
NPI:1679236855
Name:FON, ABILLO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ABILLO
Middle Name:
Last Name:FON
Suffix:
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 1:6424 VILLAGE GREEN CIR APT 8
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2676
Mailing Address - Country:US
Mailing Address - Phone:214-290-2111
Mailing Address - Fax:269-344-3415
Practice Address - Street 1:760 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4538
Practice Address - Country:US
Practice Address - Phone:269-344-1185
Practice Address - Fax:269-344-3415
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist