Provider Demographics
NPI:1356656300
Name:VERRET, ALICIA B
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:B
Last Name:VERRET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 W ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2758
Mailing Address - Country:US
Mailing Address - Phone:504-468-5479
Mailing Address - Fax:504-468-1730
Practice Address - Street 1:821 W ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2758
Practice Address - Country:US
Practice Address - Phone:504-468-5479
Practice Address - Fax:504-468-1730
Is Sole Proprietor?:No
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist