MEDICARE: DR. ALISHA MARIE GAUTHIER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	17256	LA
2	183500000X	Pharmacist	43808	LA

General Provider Information

NPI Number	:	1215186697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISHA MARIE GAUTHIER PHARMD

Provider Business Mailing Address
First Line	:	9890 LAKE FOREST BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2607
Country	:	US
Telephone Number	:	832-215-8821
Fax Number	:

Provider Business Practice Location Address
First Line	:	9890 LAKE FOREST BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2607
Country	:	US
Telephone Number	:	832-215-8821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/10/2008

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