MEDICARE: DR. KATHRYN MICHELE FOUNTAIN PHARMD

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	0202206387	VA

General Provider Information

NPI Number	:	1972596658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN MICHELE FOUNTAIN PHARMD

Provider Business Mailing Address
First Line	:	8779 BRAYS FORK DR
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-3693
Country	:	US
Telephone Number	:	804-755-4371
Fax Number	:	804-288-4027

Provider Business Practice Location Address
First Line	:	1601 WILLOW LAWN DR
Second Line	:	PHARMACY
City	:	RICHMOND
State	:	VA
Zip	:	23230-3427
Country	:	US
Telephone Number	:	804-288-3748
Fax Number	:	804-288-4027

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2007

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