1881943108 NPI number — DANA AYERS CORMIER PHARMACIST

Table of content: DANA AYERS CORMIER PHARMACIST (NPI 1881943108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881943108 NPI number — DANA AYERS CORMIER PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORMIER
Provider First Name:
DANA
Provider Middle Name:
AYERS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881943108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
192 SANDY HILL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71292-8488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-372-1767
Provider Business Mailing Address Fax Number:
318-387-7682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 COLEMAN AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
WEST MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71292-3716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-398-2100
Provider Business Practice Location Address Fax Number:
318-387-7682
Provider Enumeration Date:
08/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  12029 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12029 . This is a "LOUISIANA BOARD OF PHARMACY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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