Provider Demographics
NPI:1083872261
Name:ROULAINE, EMMETT EARL JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:EMMETT
Middle Name:EARL
Last Name:ROULAINE
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 JOHN CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4507
Mailing Address - Country:US
Mailing Address - Phone:318-323-0548
Mailing Address - Fax:318-361-7393
Practice Address - Street 1:207 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-6330
Practice Address - Country:US
Practice Address - Phone:318-361-7390
Practice Address - Fax:318-361-7393
Is Sole Proprietor?:No
Enumeration Date:2008-05-24
Last Update Date:2008-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10714OtherLOUISIANA PHARMACIST PERMIT #