Provider Demographics
NPI:1790065324
Name:MINIAS, MARIAN ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:ELIZABETH
Last Name:MINIAS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 W MCNEESE ST
Mailing Address - Street 2:APT 7206
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4291
Mailing Address - Country:US
Mailing Address - Phone:504-473-8031
Mailing Address - Fax:
Practice Address - Street 1:4097 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2819
Practice Address - Country:US
Practice Address - Phone:337-474-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA045485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist