Provider Demographics
NPI:1548401375
Name:DAVIS-DEHESA, CHRISTINE LAVON (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LAVON
Last Name:DAVIS-DEHESA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LAVON
Other - Last Name:DEHESA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1401 FOUCHER ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3515
Mailing Address - Country:US
Mailing Address - Phone:504-897-8286
Mailing Address - Fax:
Practice Address - Street 1:1401 FOUCHER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3515
Practice Address - Country:US
Practice Address - Phone:504-897-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist