Provider Demographics
NPI:1881151181
Name:CLOUDET, LATARA MARCHELLE (RPH)
Entity type:Individual
Prefix:DR
First Name:LATARA
Middle Name:MARCHELLE
Last Name:CLOUDET
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12589 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-2501
Mailing Address - Country:US
Mailing Address - Phone:985-764-1158
Mailing Address - Fax:
Practice Address - Street 1:12589 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-2501
Practice Address - Country:US
Practice Address - Phone:985-764-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist