Provider Demographics
NPI:1851808158
Name:RAWLS, JEREMY RANDEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:RANDEL
Last Name:RAWLS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36009 HIGHWAY 38
Mailing Address - Street 2:
Mailing Address - City:MOUNT HERMON
Mailing Address - State:LA
Mailing Address - Zip Code:70450-6534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36009 HIGHWAY 38
Practice Address - Street 2:
Practice Address - City:MOUNT HERMON
Practice Address - State:LA
Practice Address - Zip Code:70450-6534
Practice Address - Country:US
Practice Address - Phone:985-877-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist