Provider Demographics
NPI:1871840827
Name:PREAUS, SELENA SULLIVAN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:SULLIVAN
Last Name:PREAUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 STERLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2536
Mailing Address - Country:US
Mailing Address - Phone:318-343-3390
Mailing Address - Fax:
Practice Address - Street 1:4070 STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2536
Practice Address - Country:US
Practice Address - Phone:318-343-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.017149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist