Provider Demographics
NPI:1619092681
Name:MENGARELLI, TERRY N (PD)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:N
Last Name:MENGARELLI
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 1:320 CHURCH STREET
Mailing Address - Street 2:P.O.BOX 645
Mailing Address - City:MELVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71353-0645
Mailing Address - Country:US
Mailing Address - Phone:337-942-9992
Mailing Address - Fax:337-623-9964
Practice Address - Street 1:320 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:LA
Practice Address - Zip Code:71353-0645
Practice Address - Country:US
Practice Address - Phone:337-942-9992
Practice Address - Fax:337-623-9964
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2980IR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist