Provider Demographics
NPI:1780999631
Name:GARRISON, MYKAYLA (PHARM D)
Entity type:Individual
Prefix:
First Name:MYKAYLA
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FLORIDA AVE SE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-3735
Mailing Address - Country:US
Mailing Address - Phone:225-667-0094
Mailing Address - Fax:225-667-1669
Practice Address - Street 1:101 FLORIDA AVE SE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-3735
Practice Address - Country:US
Practice Address - Phone:225-667-0094
Practice Address - Fax:225-667-1669
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist