Provider Demographics
NPI:1720457815
Name:VESSEL, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:VESSEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 RUSSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-8522
Mailing Address - Country:US
Mailing Address - Phone:318-255-9329
Mailing Address - Fax:
Practice Address - Street 1:1311 HAZEL ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-4113
Practice Address - Country:US
Practice Address - Phone:318-263-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist