Provider Demographics
NPI:1689685141
Name:FONTANEZ, CARMEN I (RPH)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:I
Last Name:FONTANEZ
Suffix:
Gender:F
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:PO BOX 7101
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7101
Mailing Address - Country:US
Mailing Address - Phone:787-651-4312
Mailing Address - Fax:
Practice Address - Street 1:STREET VIA DEL SOL SURENA 70
Practice Address - Street 2:HACIENDA SAN JOSE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-7101
Practice Address - Country:US
Practice Address - Phone:787-651-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist