Provider Demographics
NPI:1295347458
Name:LOUISMA, JEAN W (PHARMD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:W
Last Name:LOUISMA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 S OATES ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3514
Mailing Address - Country:US
Mailing Address - Phone:250-281-2520
Mailing Address - Fax:334-678-8380
Practice Address - Street 1:1060 S OATES ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3514
Practice Address - Country:US
Practice Address - Phone:250-281-2520
Practice Address - Fax:334-678-8380
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60177183500000X
AL21183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist