Provider Demographics
NPI:1821496688
Name:MCINTYRE, VIVIAN (BS PHARM)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:LA
Mailing Address - Zip Code:71075-3241
Mailing Address - Country:US
Mailing Address - Phone:318-539-3199
Mailing Address - Fax:318-539-3197
Practice Address - Street 1:27 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:LA
Practice Address - Zip Code:71075-3241
Practice Address - Country:US
Practice Address - Phone:318-539-3199
Practice Address - Fax:318-539-3197
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA46834183500000X
ARPD11759183500000X
TX37007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist