Provider Demographics
NPI:1659528826
Name:POINDEXTER, RUTHIE ANASTASIA (CPT)
Entity Type:Individual
Prefix:MS
First Name:RUTHIE
Middle Name:ANASTASIA
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 RUE DE LAPORTE
Mailing Address - Street 2:
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512
Mailing Address - Country:US
Mailing Address - Phone:337-754-5167
Mailing Address - Fax:
Practice Address - Street 1:208 E SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-4009
Practice Address - Country:US
Practice Address - Phone:337-896-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1627183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician