Provider Demographics
NPI:1972628204
Name:PLUMER, JIMMIE WAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:WAYNE
Last Name:PLUMER
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 1:150 MAUD OLIVE DR
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-8106
Mailing Address - Country:US
Mailing Address - Phone:504-656-8095
Mailing Address - Fax:504-437-0541
Practice Address - Street 1:3001 HIGHWAY 90 W
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:LA
Practice Address - Zip Code:70094-2758
Practice Address - Country:US
Practice Address - Phone:504-437-0650
Practice Address - Fax:504-437-0541
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-8525183500000X
LA14513183500000X
AL14907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1217760Medicaid