Provider Demographics
NPI:1497342695
Name:NIELSEN, KEVIN ARNOLD (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ARNOLD
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3818
Mailing Address - Country:US
Mailing Address - Phone:985-732-2562
Mailing Address - Fax:985-732-3421
Practice Address - Street 1:330 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3818
Practice Address - Country:US
Practice Address - Phone:985-732-2562
Practice Address - Fax:985-732-3421
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist