Healthcare Provider Details

I. General information

NPI: 1578997334
Provider Name (Legal Business Name): DINNAH A VAN PELT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11430 FLORIDA BLVD
BATON ROUGE LA
70815-2403
US

IV. Provider business mailing address

641 VILLAGE LN S APT C
MANDEVILLE LA
70471-2994
US

V. Phone/Fax

Practice location:
  • Phone: 225-275-3076
  • Fax:
Mailing address:
  • Phone: 985-817-3511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPST. 020250
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: