Provider Demographics
NPI:1962756965
Name:FONTANA, ROCHELLE
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:FONTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 95TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CLYDE HILL
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1717
Mailing Address - Country:US
Mailing Address - Phone:425-577-1801
Mailing Address - Fax:
Practice Address - Street 1:2726 95TH AVE NE
Practice Address - Street 2:
Practice Address - City:CLYDE HILL
Practice Address - State:WA
Practice Address - Zip Code:98004-1717
Practice Address - Country:US
Practice Address - Phone:425-577-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000675561835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric