Healthcare Provider Details

I. General information

NPI: 1619092681
Provider Name (Legal Business Name): TERRY N. MENGARELLI PD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 CHURCH ST
MELVILLE LA
71353-0645
US

IV. Provider business mailing address

320 CHURCH STREET P.O.BOX 645
MELVILLE LA
71353-0645
US

V. Phone/Fax

Practice location:
  • Phone: 337-942-9992
  • Fax: 337-623-9964
Mailing address:
  • Phone: 337-942-9992
  • Fax: 337-623-9964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2980IR
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: