Healthcare Provider Details

I. General information

NPI: 1427207661
Provider Name (Legal Business Name): CLYDE NORRIS DEARMAN PHARMD, AE-C, CDM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 DESIARD ST STE 300
MONROE LA
71201-7363
US

IV. Provider business mailing address

130 DESIARD ST STE 300
MONROE LA
71201-7363
US

V. Phone/Fax

Practice location:
  • Phone: 318-361-0900
  • Fax: 318-361-2185
Mailing address:
  • Phone: 318-361-0900
  • Fax: 318-361-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number14413
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: