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NPI Code Detail

MEDICARE: MR. ROY HARRISON FONTENOT II

MEDICARE: MR. ROY HARRISON FONTENOT II
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
1183500000XPharmacist16434LA

General Provider Information

NPI Number : 1174740914
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROY HARRISON FONTENOT II
Provider Business Mailing Address
First Line : 40320 PELICAN POINT PKWY
Second Line :
City : GONZALES
State : LA
Zip : 70737-8510
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5061 MAIN ST
Second Line :
City : ZACHARY
State : LA
Zip : 70791-3947
Country : US
Telephone Number : 225-654-1335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 03/02/2022

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Directions to “ MR. ROY HARRISON FONTENOT II ” Practice Location

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