Provider Demographics
NPI:1255115176
Name:FONTEM, ATEMNKENG E (RPH)
Entity type:Individual
Prefix:
First Name:ATEMNKENG
Middle Name:E
Last Name:FONTEM
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 1:5401 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5150
Mailing Address - Country:US
Mailing Address - Phone:972-624-8170
Mailing Address - Fax:
Practice Address - Street 1:5401 LEBANON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5150
Practice Address - Country:US
Practice Address - Phone:972-624-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist