Provider Demographics
NPI:1164738423
Name:REVADER DUNMILES, MICHELLE YVETTE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:YVETTE
Last Name:REVADER DUNMILES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:BOUTTE
Mailing Address - State:LA
Mailing Address - Zip Code:70039-3500
Mailing Address - Country:US
Mailing Address - Phone:504-473-3965
Mailing Address - Fax:504-828-5119
Practice Address - Street 1:13500 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:BOUTTE
Practice Address - State:LA
Practice Address - Zip Code:70039-3500
Practice Address - Country:US
Practice Address - Phone:504-473-3965
Practice Address - Fax:504-828-5119
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist