Provider Demographics
NPI:1760802896
Name:NELSON, EULILIA
Entity Type:Individual
Prefix:
First Name:EULILIA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:EULILIA
Other - Middle Name:SYKES
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:925 KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6267
Mailing Address - Country:US
Mailing Address - Phone:318-352-1941
Mailing Address - Fax:
Practice Address - Street 1:925 KEYSER AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6267
Practice Address - Country:US
Practice Address - Phone:318-352-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16896183500000X
TX36553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist