Provider Demographics
NPI:1790554343
Name:LOUISELLE, CATHERINE ANN
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ANN
Last Name:LOUISELLE
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 1:12007 LAMEY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-8907
Mailing Address - Country:US
Mailing Address - Phone:228-392-2388
Mailing Address - Fax:
Practice Address - Street 1:12007 LAMEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-8907
Practice Address - Country:US
Practice Address - Phone:228-392-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT221871183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician