Provider Demographics
NPI:1821398926
Name:PERSON, MONTY KARL (PD)
Entity Type:Individual
Prefix:MR
First Name:MONTY
Middle Name:KARL
Last Name:PERSON
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5349
Mailing Address - Country:US
Mailing Address - Phone:337-546-6381
Mailing Address - Fax:337-546-1180
Practice Address - Street 1:621 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5349
Practice Address - Country:US
Practice Address - Phone:337-546-6381
Practice Address - Fax:337-546-1180
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist