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General NPI Number Information
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NPI Number | 1497164206
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Entity Type | Organization
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Legal Business Name | ALPHAMED CORPORATION, LLC
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 5128 LAPALCO BLVD SUITE E
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City | MARRERO
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State | LA
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Zip | 70072-4249
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Country | US
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Telephone | 985-445-3154
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2231
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City | SLIDELL
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State | LA
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Zip | 70459-2231
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAMON S COUSIN SR.
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Credential | PHARM.D.
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Telephone | 985-445-3154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 15422
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License Number State | LA
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