Provider Demographics
NPI:1669033726
Name:EWING, OLIVIA FAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:FAY
Last Name:EWING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:FAY
Other - Last Name:GOSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:814 MUSCADINE RD
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-5149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1204 THE BLVD
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-6219
Practice Address - Country:US
Practice Address - Phone:337-334-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist