MEDICARE: MR. DONALD KERMIT FELLOWS JR. P.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	9677	LA

General Provider Information

NPI Number	:	1275670663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD KERMIT FELLOWS JR. P.D.

Provider Business Mailing Address
First Line	:	125 E THOMAS ST
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-3313
Country	:	US
Telephone Number	:	985-345-5120
Fax Number	:	985-345-5178

Provider Business Practice Location Address
First Line	:	125 E THOMAS ST
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-3313
Country	:	US
Telephone Number	:	985-345-5120
Fax Number	:	985-345-5178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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