Provider Demographics
NPI:1134112204
Name:MOULIERE, ROBIN D (PD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:D
Last Name:MOULIERE
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2751
Mailing Address - Country:US
Mailing Address - Phone:318-445-2575
Mailing Address - Fax:318-484-9457
Practice Address - Street 1:1305 WINDSOR PL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2751
Practice Address - Country:US
Practice Address - Phone:318-445-2575
Practice Address - Fax:318-484-9457
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist