Healthcare Provider Details

I. General information

NPI: 1659630788
Provider Name (Legal Business Name): AARON MABOU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 HIGHWAY 3
BENTON LA
71006-3492
US

IV. Provider business mailing address

6280 HIGHWAY 3
BENTON LA
71006-3492
US

V. Phone/Fax

Practice location:
  • Phone: 318-965-3669
  • Fax:
Mailing address:
  • Phone: 318-965-3669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17395
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: