Provider Demographics
NPI:1578997334
Name:VAN PELT, DINNAH A (PHARMD)
Entity Type:Individual
Prefix:
First Name:DINNAH
Middle Name:A
Last Name:VAN PELT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 VILLAGE LN S APT C
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2994
Mailing Address - Country:US
Mailing Address - Phone:985-817-3511
Mailing Address - Fax:
Practice Address - Street 1:11430 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-2403
Practice Address - Country:US
Practice Address - Phone:225-275-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST. 0202501835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy