Provider Demographics
NPI:1376098038
Name:MOURET, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MOURET
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 1:406 KYLE LANDRY RD
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-0942
Mailing Address - Country:US
Mailing Address - Phone:337-367-7208
Mailing Address - Fax:337-369-9344
Practice Address - Street 1:1150 W SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3558
Practice Address - Country:US
Practice Address - Phone:337-367-3333
Practice Address - Fax:337-369-9344
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.010982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist