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General NPI Number Information
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NPI Number | 1093826877
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Entity Type | Individual
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Provider Name | KEVIN KENT MIANO RPH
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1830 W AIRLINE HWY
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City | LA PLACE
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State | LA
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Zip | 70068-3335
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Country | US
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Telephone | 985-653-9974
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Fax | 985-653-9980
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Provider Business Mailing Address
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Address Line | 39704 ROU MAR NEI DR
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City | PONCHATOULA
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State | LA
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Zip | 70454-6485
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Country | US
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Telephone | 985-370-5767
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Fax | 985-653-9980
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10569
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License Number State | LA
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