Provider Demographics
NPI:1114533593
Name:SAINT LOUIS, MARC AVEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:AVEL
Last Name:SAINT LOUIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 SHERWOOD WAY APT 4212
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5638
Mailing Address - Country:US
Mailing Address - Phone:631-339-8598
Mailing Address - Fax:
Practice Address - Street 1:3328 SHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3529
Practice Address - Country:US
Practice Address - Phone:325-947-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty