Provider Demographics
NPI:1053648634
Name:CASANOVA, DAVID EMILE (PD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EMILE
Last Name:CASANOVA
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31696 HWY 22
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:70462
Mailing Address - Country:US
Mailing Address - Phone:225-294-5048
Mailing Address - Fax:225-294-2142
Practice Address - Street 1:31696 HWY 22
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:LA
Practice Address - Zip Code:70462
Practice Address - Country:US
Practice Address - Phone:225-294-5048
Practice Address - Fax:225-294-2142
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16554183500000X
MST010151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist