Provider Demographics
NPI:1508077181
Name:CORE, MOMI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MOMI
Middle Name:
Last Name:CORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78553 FAUCHEAUX RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-3307
Mailing Address - Country:US
Mailing Address - Phone:985-796-8799
Mailing Address - Fax:
Practice Address - Street 1:1919 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-3689
Practice Address - Country:US
Practice Address - Phone:985-839-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist