Provider Demographics
NPI:1003198078
Name:DEPAULA, SALVADOR NORMAN
Entity Type:Individual
Prefix:MR
First Name:SALVADOR
Middle Name:NORMAN
Last Name:DEPAULA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10124 JENKINS LN
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2931
Mailing Address - Country:US
Mailing Address - Phone:985-974-3754
Mailing Address - Fax:
Practice Address - Street 1:2300 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2830
Practice Address - Country:US
Practice Address - Phone:985-345-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist