Provider Demographics
NPI:1417262460
Name:HUMPHREYS, MONICA S
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:S
Last Name:HUMPHREYS
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 1:4100 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2203
Mailing Address - Country:US
Mailing Address - Phone:504-463-3170
Mailing Address - Fax:504-463-5989
Practice Address - Street 1:4100 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2203
Practice Address - Country:US
Practice Address - Phone:504-463-3170
Practice Address - Fax:504-463-5989
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
LA13929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist