Provider Demographics
NPI:1609904309
Name:MECHE, RAPHAEL J (PD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:J
Last Name:MECHE
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CEDAR PARK
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-6612
Mailing Address - Country:US
Mailing Address - Phone:337-334-2240
Mailing Address - Fax:
Practice Address - Street 1:913 THE BLVD
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-6134
Practice Address - Country:US
Practice Address - Phone:337-334-3399
Practice Address - Fax:337-334-3339
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist