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NPI Code Detail

MEDICARE: MR. COURTNEY MICHAEL VILLAVASSO SR. RPH

MEDICARE:  MR. COURTNEY MICHAEL VILLAVASSO SR. RPH
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
1183500000XPharmacist14546LA

General Provider Information

NPI Number : 1417224478
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. COURTNEY MICHAEL VILLAVASSO SR. RPH
Provider Business Mailing Address
First Line : 4640 SAN MARCO RD
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70129-2635
Country : US
Telephone Number : 281-725-4985
Fax Number :
Provider Business Practice Location Address
First Line : 6800 GREENWELL SPRINGS RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70805-7436
Country : US
Telephone Number : 225-216-9442
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2011
Last Update Date : 11/18/2011

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Directions to “ MR. COURTNEY MICHAEL VILLAVASSO SR. RPH” Practice Location

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