NPI 1104337559

Paul van Deventer MD Apmc

Organisation Non-Pharmacy Dispensing Site Covington, LA

Practice location

Address: 1200 Pinnacle Pkwy STE 3, Covington, LA 70433-9169
Phone: (479) 636-9702
Fax: (877) 427-2307
Mailing address: PO Box 3328, Bentonville, AR 72712

Authorised official

Name: Mackenzie Hahn
Title: Ncpdp Coordinator
Phone: (479) 636-9702

Registered specialties

Non-Pharmacy Dispensing Site Primary

Suppliers Taxonomy 332900000X Licence MD.025612 (LA)

Other Non-Pharmacy Dispensing Site providers in Louisiana →

Registry record

NPI: 1104337559
Entity type: Organization
NPI issued: 12 Oct 2017
Record last updated: 16 Nov 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.