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General NPI Number Information
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NPI Number | 1760797518
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Entity Type | Individual
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Provider Name | RICHARD MICHAEL INDOVINA JR.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 3330 W ESPLANADE AVE S
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City | METAIRIE
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State | LA
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Zip | 70002-3454
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Country | US
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Telephone | 504-828-5071
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 MOSS LN
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City | RIVER RIDGE
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State | LA
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Zip | 70123-2739
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Country | US
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Telephone | 504-737-7752
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Fax |
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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 | 15322
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License Number State | LA
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