1538680228 NPI number — DR. MEGAN PRICE BERTHELOT PHARMD

Table of content: DR. MEGAN PRICE BERTHELOT PHARMD (NPI 1538680228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538680228 NPI number — DR. MEGAN PRICE BERTHELOT PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERTHELOT
Provider First Name:
MEGAN
Provider Middle Name:
PRICE
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:
PRICE
Provider Other First Name:
MEGAN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538680228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12845 ARNOLD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALKER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70785-4416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-937-2349
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29881 WALKER SOUTH RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALKER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-665-4580
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2017

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:  PNT.047453 , 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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