Provider Demographics
NPI:1831230820
Name:GARRETT, RAYMOND H SR (PHARMACIST DR)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:H
Last Name:GARRETT
Suffix:SR
Gender:M
Credentials:PHARMACIST DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROADS
Mailing Address - State:LA
Mailing Address - Zip Code:70760-3635
Mailing Address - Country:US
Mailing Address - Phone:225-638-7550
Mailing Address - Fax:225-638-7300
Practice Address - Street 1:303 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-3635
Practice Address - Country:US
Practice Address - Phone:225-638-7550
Practice Address - Fax:225-638-7300
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1257346Medicaid