Provider Demographics
NPI:1699175950
Name:BELANGER, MARVIN (RPH)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:BELANGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 BAYOU BLUE RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-3909
Mailing Address - Country:US
Mailing Address - Phone:985-876-5502
Mailing Address - Fax:
Practice Address - Street 1:2138 BAYOU BLUE RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-3909
Practice Address - Country:US
Practice Address - Phone:985-876-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-23
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.011491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist