Provider Demographics
NPI:1992581334
Name:FOUNTAIN6 INVESTMENT COMPANY LLC
Entity type:Organization
Organization Name:FOUNTAIN6 INVESTMENT COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOIL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-671-9000
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-0783
Mailing Address - Country:US
Mailing Address - Phone:910-671-9000
Mailing Address - Fax:
Practice Address - Street 1:4307 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2676
Practice Address - Country:US
Practice Address - Phone:910-671-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy