Healthcare Provider Details

I. General information

NPI: 1427722040
Provider Name (Legal Business Name): ALEXIS GASPARD DYSART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 HIGHWAY 59
MANDEVILLE LA
70471-1936
US

IV. Provider business mailing address

2803 HIGHWAY 59
MANDEVILLE LA
70471-1936
US

V. Phone/Fax

Practice location:
  • Phone: 985-626-0234
  • Fax:
Mailing address:
  • Phone: 985-626-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.023955
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: