Provider Demographics
NPI:1184901670
Name:FONTANA, RICCI LOUIS (PHARM D)
Entity type:Individual
Prefix:DR
First Name:RICCI
Middle Name:LOUIS
Last Name:FONTANA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10870 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3455
Mailing Address - Country:US
Mailing Address - Phone:954-651-7075
Mailing Address - Fax:
Practice Address - Street 1:10870 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3455
Practice Address - Country:US
Practice Address - Phone:954-651-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist