Healthcare Provider Details

I. General information

NPI: 1265716088
Provider Name (Legal Business Name): DR. APRIL M ROUSSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12589 AIRLINE HWY
DESTREHAN LA
70047-2501
US

IV. Provider business mailing address

211 GOURGUES ST
HAHNVILLE LA
70057-2380
US

V. Phone/Fax

Practice location:
  • Phone: 985-764-1158
  • Fax: 985-764-3142
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17144
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: