MEDICARE: FIDELIS KAMUNTU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302042689	MI

General Provider Information

NPI Number	:	1114327178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIDELIS KAMUNTU

Provider Business Mailing Address
First Line	:	146 N CORNING ST
Second Line	:
City	:	FARWELL
State	:	MI
Zip	:	48622-9737
Country	:	US
Telephone Number	:	989-588-2599
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 N CORNING ST
Second Line	:
City	:	FARWELL
State	:	MI
Zip	:	48622-9737
Country	:	US
Telephone Number	:	989-588-2599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	08/27/2014

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Directions to “ FIDELIS KAMUNTU ” Practice Location

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