Provider Demographics
NPI:1013215144
Name:LANDRY, DAWN DOMINGUE (RPH)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:DOMINGUE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 N VICTOR II BLVD
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1327
Mailing Address - Country:US
Mailing Address - Phone:985-385-2794
Mailing Address - Fax:985-702-1593
Practice Address - Street 1:1223 N VICTOR II BLVD
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1327
Practice Address - Country:US
Practice Address - Phone:985-385-2794
Practice Address - Fax:985-702-1593
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist