Bertrand Fontem, PHARMD
Individual provider Active NPI Pharmacist · Carrollton, MO
NPI 1568067239 · NPPES record last updated Dec 1, 2020
Key facts
- NPI
- 1568067239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2018031227 (MO)
- Practice address
- 1003 N US Highway 65
Carrollton, MO 64633-1972 - Phone
- (660) 542-1111
- Fax
- (660) 542-3051
- NPI assigned
- Dec 1, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2018031227 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2018031227 | MO | Yes |
Addresses
Primary practice location
1003 N US Highway 65
Carrollton, MO 64633-1972
Mailing address
1003 N US Highway 65
Carrollton, MO 64633-1972
Phone (660) 542-1111
Other providers in Carrollton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.