Provider Demographics
NPI:1790377216
Name:FENTON, ABIGAIL MARIE (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:MARIE
Last Name:FENTON
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:DR
Other - First Name:ABBY
Other - Middle Name:MARIE
Other - Last Name:FENTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, MBA
Mailing Address - Street 1:205 OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:LAURIUM
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2134
Mailing Address - Country:US
Mailing Address - Phone:906-337-6500
Mailing Address - Fax:906-337-6576
Practice Address - Street 1:205 OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2134
Practice Address - Country:US
Practice Address - Phone:906-337-6575
Practice Address - Fax:906-337-6576
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist