Provider Demographics
NPI:1528308426
Name:FONTENOT, BARNEY JUDE (RPH)
Entity type:Individual
Prefix:
First Name:BARNEY
Middle Name:JUDE
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 THOUSAND OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247
Mailing Address - Country:US
Mailing Address - Phone:210-491-9976
Mailing Address - Fax:
Practice Address - Street 1:2929 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3312
Practice Address - Country:US
Practice Address - Phone:210-491-9976
Practice Address - Fax:210-491-9789
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25290183500000X
LAPST.013092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist