Individual
MISS MICHELLE GUADALUPE FUENTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
6730 LONEWOOD DR, COLORADO SPRINGS, CO 80925-9548
(719) 964-9514
Mailing address
6730 LONEWOOD DR, COLORADO SPRINGS, CO 80925-9548
(719) 964-9514
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
PHAT0000195
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHAT.0000195
COLORADO STATE BOARD OF PHARMACY
CO
Enumeration date
04/09/2021
Last updated
04/09/2021
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