Provider Demographics
NPI:1962832949
Name:FONTANEY-DIMANDO, ADRIANNA (PHARMD)
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:
Last Name:FONTANEY-DIMANDO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9527 GOLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5204
Mailing Address - Country:US
Mailing Address - Phone:210-862-5282
Mailing Address - Fax:
Practice Address - Street 1:10673 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1346
Practice Address - Country:US
Practice Address - Phone:210-647-9842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist