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NPI Code Detail

MEDICARE: MR. MARK R MALOUSE R.PH.

MEDICARE: MR. MARK R MALOUSE R.PH.
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
1183500000XPharmacist13787LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113787OTHERLAPHARMACIST LICENSE

General Provider Information

NPI Number : 1700857091
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK R MALOUSE R.PH.
Provider Business Mailing Address
First Line : 2716 DAUPHINE ST
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70117-7322
Country : US
Telephone Number : 504-944-1114
Fax Number : 504-944-1114
Provider Business Practice Location Address
First Line : 1010 COMMON ST
Second Line : SUITE A1460
City : NEW ORLEANS
State : LA
Zip : 70112-2401
Country : US
Telephone Number : 504-568-7097
Fax Number : 504-568-8306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 08/05/2009

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Directions to “ MR. MARK R MALOUSE R.PH.” Practice Location

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