Provider Demographics
NPI:1043311780
Name:DE JESUS, FRANK
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:DE JESUS
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 1:2017 S GLENCOVE LN
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5227
Mailing Address - Country:US
Mailing Address - Phone:504-310-6216
Mailing Address - Fax:504-310-6200
Practice Address - Street 1:1601 PERDIDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1262
Practice Address - Country:US
Practice Address - Phone:504-568-0811
Practice Address - Fax:504-310-6200
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist