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General NPI Number Information
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NPI Number | 1922512235
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Entity Type | Individual
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Provider Name | RUSTY PAUL MANUEL PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 3330 MASONIC DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3841
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Country | US
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Telephone | 318-448-6785
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Fax |
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Provider Business Mailing Address
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Address Line | 1464 CREOSOTE LN
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City | MAMOU
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State | LA
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Zip | 70554-4753
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Country | US
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Telephone | 337-789-1573
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 18464
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License Number State | LA
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