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General NPI Number Information
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NPI Number | 1477520377
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Entity Type | Organization
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Legal Business Name | S. FOUNTAIN'S INC
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 133 NEWMAN ST
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City | EAST TAWAS
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State | MI
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Zip | 48730
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Country | US
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Telephone | 989-362-7415
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Fax | 989-362-0597
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Provider Business Mailing Address
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Address Line | 133 NEWMAN ST
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City | EAST TAWAS
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State | MI
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Zip | 48730
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Country | US
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Telephone | 989-362-7415
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Fax | 989-362-0597
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Authorized Official
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Title or Position | OWNER/PRES
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Name | MR. STEVEN MARK FOUNTAIN
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Credential | R.PH.
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Telephone | 989-362-7415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | MI
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