Provider Demographics
NPI:1164577375
Name:GOUX, KINMAN P
Entity Type:Individual
Prefix:MR
First Name:KINMAN
Middle Name:P
Last Name:GOUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-0526
Mailing Address - Country:US
Mailing Address - Phone:318-240-9866
Mailing Address - Fax:318-240-8849
Practice Address - Street 1:336 CENTER ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2867
Practice Address - Country:US
Practice Address - Phone:318-240-9866
Practice Address - Fax:318-240-8849
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist