Healthcare Provider Details

I. General information

NPI: 1710989769
Provider Name (Legal Business Name): NOLTON W CAUSEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 BIENVILLE ST
NATCHITOCHES LA
71457-5702
US

IV. Provider business mailing address

161 SAINT CHARLES AVE
NATCHITOCHES LA
71457-2824
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-3141
  • Fax: 318-357-0976
Mailing address:
  • Phone: 318-352-3141
  • Fax: 318-357-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9702
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: