1215237557 NPI number — MRS. MONICA MAYFIELD ARMSTRONG MONICA MARKEY

Table of content: ELIZABETH PRIETO (NPI 1881191047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215237557 NPI number — MRS. MONICA MAYFIELD ARMSTRONG MONICA MARKEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMSTRONG
Provider First Name:
MONICA
Provider Middle Name:
MAYFIELD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MONICA MARKEY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARKEY
Provider Other First Name:
MONICA
Provider Other Middle Name:
MAYFIELD
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215237557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10200 FLORIDA BLVD WALGREENS 11762
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-664-5181
Provider Business Mailing Address Fax Number:
225-664-5859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3081 S. RANGE AVE WALGREENS 13080
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-664-8094
Provider Business Practice Location Address Fax Number:
225-664-8496
Provider Enumeration Date:
11/02/2010

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:  17317 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: T-010112 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2350633 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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