Provider Demographics
NPI:1649908708
Name:MUSE, KILEIGH B (PHARMD)
Entity type:Individual
Prefix:
First Name:KILEIGH
Middle Name:B
Last Name:MUSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KILEIGH
Other - Middle Name:TARA
Other - Last Name:BETHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:71271 HIGHWAY 1054
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-6727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1116 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-1847
Practice Address - Country:US
Practice Address - Phone:985-839-6382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist