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NPI Code Detail

MEDICARE: DR. DESHAWN D. FONTENOT PHARM. D.

MEDICARE:  DR. DESHAWN D. FONTENOT  PHARM. D.
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
1183500000XPharmacist47067TX

General Provider Information

NPI Number : 1477849370
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DESHAWN D. FONTENOT PHARM. D.
Provider Business Mailing Address
First Line : 5270 S STATE HIGHWAY 360
Second Line : T-2243
City : GRAND PRAIRIE
State : TX
Zip : 75052-8307
Country : US
Telephone Number : 469-348-2101
Fax Number : 469-348-2104
Provider Business Practice Location Address
First Line : 5270 S STATE HIGHWAY 360
Second Line : T-2243
City : GRAND PRAIRIE
State : TX
Zip : 75052-8307
Country : US
Telephone Number : 469-348-2101
Fax Number : 469-348-2104
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2011
Last Update Date : 06/20/2011

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Directions to “ DR. DESHAWN D. FONTENOT PHARM. D.” Practice Location

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