Provider Demographics
NPI:1093826877
Name:MIANO, KEVIN KENT (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:KENT
Last Name:MIANO
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 1:39704 ROU MAR NEI DR
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-6485
Mailing Address - Country:US
Mailing Address - Phone:985-370-5767
Mailing Address - Fax:985-653-9980
Practice Address - Street 1:1830 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3335
Practice Address - Country:US
Practice Address - Phone:985-653-9974
Practice Address - Fax:985-653-9980
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist