Provider Demographics
NPI:1780394585
Name:DEVEER, ROBERT CHARLES JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:DEVEER
Suffix:JR
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 1:38128 HENRY RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4117
Mailing Address - Country:US
Mailing Address - Phone:225-278-3166
Mailing Address - Fax:
Practice Address - Street 1:17585 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3303
Practice Address - Country:US
Practice Address - Phone:225-677-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14180183500000X
LA014180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist