MEDICARE: S. FOUNTAIN'S INC

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	3336C0003X	Community/Retail Pharmacy		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2349517	OTHER	MI	NABP

General Provider Information

NPI Number	:	1477520377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. FOUNTAIN'S INC

Provider Business Mailing Address
First Line	:	133 NEWMAN ST
Second Line	:
City	:	EAST TAWAS
State	:	MI
Zip	:	48730
Country	:	US
Telephone Number	:	989-362-7415
Fax Number	:	989-362-0597

Provider Business Practice Location Address
First Line	:	133 NEWMAN ST
Second Line	:
City	:	EAST TAWAS
State	:	MI
Zip	:	48730
Country	:	US
Telephone Number	:	989-362-7415
Fax Number	:	989-362-0597

Authorized Official
Title or Position	:	OWNER/PRES
Name	:	MR. STEVEN MARK FOUNTAIN
Credential	:	R.PH.
Telephone Number	:	989-362-7415

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	03/07/2023

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Directions to “S. FOUNTAIN'S INC ” Practice Location

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