Provider Demographics
NPI:1396021226
Name:BARRIOS, DESIRAE ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:ELIZABETH
Last Name:BARRIOS
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 1:202 E 37TH PL
Mailing Address - Street 2:202 EAST 37TH PLACE
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-2618
Mailing Address - Country:US
Mailing Address - Phone:985-696-1103
Mailing Address - Fax:
Practice Address - Street 1:13998 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAROSE
Practice Address - State:LA
Practice Address - Zip Code:70373-3009
Practice Address - Country:US
Practice Address - Phone:985-693-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.019648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist