Provider Demographics
NPI:1295056414
Name:FONTANA, BARBARA S
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:S
Last Name:FONTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414C MARY ESTHER CUTOFF NW
Mailing Address - Street 2:
Mailing Address - City:FT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-7819
Mailing Address - Country:US
Mailing Address - Phone:850-244-1403
Mailing Address - Fax:
Practice Address - Street 1:414C MARY ESTHER CUTOFF
Practice Address - Street 2:
Practice Address - City:FT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-7819
Practice Address - Country:US
Practice Address - Phone:850-244-1403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44706183500000X
PARP442858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist