Provider Demographics
NPI:1396050415
Name:FONTENOT, FORREST (PHARM D)
Entity type:Individual
Prefix:MR
First Name:FORREST
Middle Name:
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-5285
Mailing Address - Country:US
Mailing Address - Phone:337-266-5884
Mailing Address - Fax:337-266-8495
Practice Address - Street 1:1000 SAINT MARY STREET
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583
Practice Address - Country:US
Practice Address - Phone:337-235-5216
Practice Address - Fax:337-235-5217
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist