Provider Demographics
NPI:1336421155
Name:DESSELLE, JOAN ROSELYN (RPH)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ROSELYN
Last Name:DESSELLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WINSOR DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-5646
Mailing Address - Country:US
Mailing Address - Phone:337-351-5501
Mailing Address - Fax:
Practice Address - Street 1:820G E ADMIRAL DOYLE DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6747
Practice Address - Country:US
Practice Address - Phone:337-365-2436
Practice Address - Fax:337-369-7264
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist