Provider Demographics
NPI:1023648276
Name:FOUNTAIN, JAMES AUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:AUSTIN
Last Name:FOUNTAIN
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 1:2631 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3581
Mailing Address - Country:US
Mailing Address - Phone:812-275-7134
Mailing Address - Fax:812-275-7205
Practice Address - Street 1:2631 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3581
Practice Address - Country:US
Practice Address - Phone:812-275-7134
Practice Address - Fax:812-275-7205
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027747A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist