Healthcare Provider Details

I. General information

NPI: 1932358702
Provider Name (Legal Business Name): PHILIPPE EMILE PUCHEU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 PARK ROWE AVE SUITE 600
BATON ROUGE LA
70810-1686
US

IV. Provider business mailing address

PO BOX 83352
BATON ROUGE LA
70884-3352
US

V. Phone/Fax

Practice location:
  • Phone: 225-906-4961
  • Fax: 225-906-4829
Mailing address:
  • Phone:
  • Fax: 888-492-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18455
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: