Provider Demographics
NPI:1124356969
Name:LANDRY, CARLA JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEAN
Last Name:LANDRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 FM 2920 RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3412
Mailing Address - Country:US
Mailing Address - Phone:281-288-9008
Mailing Address - Fax:281-288-9074
Practice Address - Street 1:2103 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3412
Practice Address - Country:US
Practice Address - Phone:281-288-9008
Practice Address - Fax:281-288-9074
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist