Provider Demographics
NPI:1598315558
Name:OREAR, AUTUMN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:
Last Name:OREAR
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 1:74557 IOTA AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5405
Mailing Address - Country:US
Mailing Address - Phone:210-870-4648
Mailing Address - Fax:
Practice Address - Street 1:9194 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3123
Practice Address - Country:US
Practice Address - Phone:318-687-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist