Provider Demographics
NPI:1235783580
Name:MAYER, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MAYER
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 1:128 CURRAN LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-7222
Mailing Address - Country:US
Mailing Address - Phone:337-991-0101
Mailing Address - Fax:
Practice Address - Street 1:620 GUILBEAU RD STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-8709
Practice Address - Country:US
Practice Address - Phone:337-654-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist