Provider Demographics
NPI:1013092329
Name:LAVENUE, JAMES LOUIS (DPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LOUIS
Last Name:LAVENUE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 REBECCA LN
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-1146
Mailing Address - Country:US
Mailing Address - Phone:731-696-2976
Mailing Address - Fax:731-696-2204
Practice Address - Street 1:8 N CAVALIER DR
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-6468
Practice Address - Country:US
Practice Address - Phone:731-696-2266
Practice Address - Fax:731-696-2204
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist