Provider Demographics
NPI:1013929801
Name:NAQUIN, MYRA L (CPHT)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:L
Last Name:NAQUIN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6141
Mailing Address - Country:US
Mailing Address - Phone:985-447-3746
Mailing Address - Fax:985-447-2853
Practice Address - Street 1:1772 CANAL BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5225
Practice Address - Country:US
Practice Address - Phone:985-447-3746
Practice Address - Fax:985-447-2853
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7240PT183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician