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NPI Code Detail

MEDICARE: MR. MICHAEL RUSSELL DORMAN PHARMACIST

MEDICARE: MR. MICHAEL RUSSELL DORMAN PHARMACIST
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
1183500000XPharmacist14481LA

General Provider Information

NPI Number : 1780686121
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL RUSSELL DORMAN PHARMACIST
Provider Business Mailing Address
First Line : 15442 CAMPANILE CT
Second Line :
City : BATON ROUGE
State : LA
Zip : 70810-0309
Country : US
Telephone Number : 225-358-3920
Fax Number : 225-358-1158
Provider Business Practice Location Address
First Line : 5825 AIRLINE HWY
Second Line :
City : BATON ROUGE
State : LA
Zip : 70805-2408
Country : US
Telephone Number : 225-358-3920
Fax Number : 225-358-1158
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/08/2007

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