Provider Demographics
NPI:1235361171
Name:DUBOIS, LOUISA MAE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:MAE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S 63RD ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-3311
Mailing Address - Country:US
Mailing Address - Phone:253-238-5265
Mailing Address - Fax:
Practice Address - Street 1:2622 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1500
Practice Address - Country:US
Practice Address - Phone:253-697-2801
Practice Address - Fax:253-770-5175
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60091758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist