Provider Demographics
NPI:1053945634
Name:FONTEM, BELLE E (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:BELLE
Middle Name:E
Last Name:FONTEM
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 MALLARDS MARSH
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-9300
Mailing Address - Country:US
Mailing Address - Phone:682-704-1557
Mailing Address - Fax:
Practice Address - Street 1:4633 MORSE CENTRE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6601
Practice Address - Country:US
Practice Address - Phone:682-704-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist