Provider Demographics
NPI:1578079661
Name:GOMLA, WILLIAM PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PAUL
Last Name:GOMLA
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 1:932 CARROLLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAPLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068
Mailing Address - Country:US
Mailing Address - Phone:985-652-1245
Mailing Address - Fax:985-652-7239
Practice Address - Street 1:932 CARROLLWOOD AVE.
Practice Address - Street 2:
Practice Address - City:LAPLACE
Practice Address - State:LA
Practice Address - Zip Code:70068
Practice Address - Country:US
Practice Address - Phone:985-652-1245
Practice Address - Fax:985-652-7239
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1898368Medicaid