Healthcare Provider Details

I. General information

NPI: 1376098038
Provider Name (Legal Business Name): JAMES MOURET
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 W SAINT PETER ST
NEW IBERIA LA
70560-3558
US

IV. Provider business mailing address

406 KYLE LANDRY RD
NEW IBERIA LA
70563-0942
US

V. Phone/Fax

Practice location:
  • Phone: 337-367-3333
  • Fax: 337-369-9344
Mailing address:
  • Phone: 337-367-7208
  • Fax: 337-369-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.010982
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: