Provider Demographics
NPI:1972596658
Name:FOUNTAIN, KATHRYN MICHELE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MICHELE
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8779 BRAYS FORK DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3693
Mailing Address - Country:US
Mailing Address - Phone:804-755-4371
Mailing Address - Fax:804-288-4027
Practice Address - Street 1:1601 WILLOW LAWN DR
Practice Address - Street 2:PHARMACY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3427
Practice Address - Country:US
Practice Address - Phone:804-288-3748
Practice Address - Fax:804-288-4027
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist