1518249549 NPI number — DR. DWAINA BRIMMER MARKEY PHARMD

Table of content: DR. DWAINA BRIMMER MARKEY PHARMD (NPI 1518249549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518249549 NPI number — DR. DWAINA BRIMMER MARKEY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARKEY
Provider First Name:
DWAINA
Provider Middle Name:
BRIMMER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRIMMER
Provider Other First Name:
DWAINA
Provider Other Middle Name:
CATRICE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518249549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50
Provider Second Line Business Mailing Address:
1313 PAUL MALLARD SUITE A
Provider Business Mailing Address City Name:
LULING
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70070-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-785-1753
Provider Business Mailing Address Fax Number:
985-785-9784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 PAUL MAILLARD RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LULING
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70070-4549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-785-1753
Provider Business Practice Location Address Fax Number:
985-785-9784
Provider Enumeration Date:
09/15/2011

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:  16631 , 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)





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