=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558760553
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALCOLM MICHAEL ARMSTRONG SR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2014
-----------------------------------------------------
Last Update Date | 08/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3009 E CAUSEWAY APPROACH
-----------------------------------------------------
City | MANDEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70448-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-626-1118
-----------------------------------------------------
Fax | 985-626-1611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3009 E CAUSEWAY APPROACH
-----------------------------------------------------
City | MANDEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-626-1118
-----------------------------------------------------
Fax | 985-626-1611
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 014691
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 015295
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 106308
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------