Provider Demographics
NPI:1093141525
Name:SINITIERE, MOISE (RPH)
Entity Type:Individual
Prefix:
First Name:MOISE
Middle Name:
Last Name:SINITIERE
Suffix:
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 1:8058 CAPTAIN MARY MILLER DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2947
Mailing Address - Country:US
Mailing Address - Phone:318-798-5764
Mailing Address - Fax:
Practice Address - Street 1:9250 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3125
Practice Address - Country:US
Practice Address - Phone:318-686-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist