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General NPI Number Information
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NPI Number | 1215141098
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Entity Type | Organization
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Legal Business Name | ROLAND S. WAGUESPACK MD
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1108 SAINT JAMES ST
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City | VACHERIE
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State | LA
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Zip | 70090-5320
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Country | US
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Telephone | 225-265-4087
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Fax | 225-265-4006
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Provider Business Mailing Address
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Address Line | 1108 SAINT JAMES ST
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City | VACHERIE
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State | LA
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Zip | 70090-5320
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Country | US
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Telephone | 225-265-4087
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Fax | 225-265-4006
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Authorized Official
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Title or Position | M.D.
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Name | DR. ROLAND S WAGUESPACK
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Credential | M.D.
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Telephone | 225-265-4087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 009974
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License Number State | LA
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