Healthcare Provider Details

I. General information

NPI: 1487240735
Provider Name (Legal Business Name): ERHARD VITEL DZOUANKEU KAMDOUM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2020
Last Update Date: 12/20/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 E MILTON AVE
YOUNGSVILLE LA
70592-6766
US

IV. Provider business mailing address

2910 E MILTON AVE
YOUNGSVILLE LA
70592-6766
US

V. Phone/Fax

Practice location:
  • Phone: 337-856-8881
  • Fax:
Mailing address:
  • Phone: 337-856-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.023413
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: