Provider Demographics
NPI:1912196361
Name:SERRETTE, REYNOLD JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:REYNOLD
Middle Name:JAMES
Last Name:SERRETTE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3723
Mailing Address - Country:US
Mailing Address - Phone:337-828-3392
Mailing Address - Fax:337-828-3414
Practice Address - Street 1:1524 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3723
Practice Address - Country:US
Practice Address - Phone:337-828-3392
Practice Address - Fax:337-828-3414
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist