Provider Demographics
NPI:1760909428
Name:DEPAULA, ASHLEY MARIE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:DEPAULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 OLD BATON ROUGE HWY
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2732
Mailing Address - Country:US
Mailing Address - Phone:985-974-7764
Mailing Address - Fax:
Practice Address - Street 1:19089 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711-3603
Practice Address - Country:US
Practice Address - Phone:225-567-7772
Practice Address - Fax:225-567-7773
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist