Provider Demographics
NPI:1831738913
Name:LAFONTAINE, ROSA M (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:LAFONTAINE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 8 BOX 64052
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-5915
Mailing Address - Country:US
Mailing Address - Phone:787-881-3434
Mailing Address - Fax:787-881-0065
Practice Address - Street 1:BO. SANTANA ZONA INDUSTRIAL
Practice Address - Street 2:CARR 2 KM 67.7
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-881-3434
Practice Address - Fax:787-881-0065
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3491OtherPHARMACIST LICENS