Provider Demographics
NPI:1558470054
Name:PLAISANCE, GARY ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ANTHONY
Last Name:PLAISANCE
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 1:2529 DEUTSCH RD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-5706
Mailing Address - Country:US
Mailing Address - Phone:504-341-7558
Mailing Address - Fax:504-341-7558
Practice Address - Street 1:3645 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2329
Practice Address - Country:US
Practice Address - Phone:504-348-1321
Practice Address - Fax:504-348-1149
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist