Individual
MICHAEL FONCANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD, RPH
Contact information
Practice address
620 W PLATTE AVE, FORT MORGAN, CO 80701-2652
(970) 867-3027
Mailing address
620 W PLATTE AVE, FORT MORGAN, CO 80701-2652
(970) 867-3027
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
19939
CO
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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