Provider Demographics
NPI:1881943108
Name:CORMIER, DANA AYERS (PHARMACIST)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:AYERS
Last Name:CORMIER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 SANDY HILL CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-8488
Mailing Address - Country:US
Mailing Address - Phone:318-372-1767
Mailing Address - Fax:318-387-7682
Practice Address - Street 1:707 COLEMAN AVE
Practice Address - Street 2:STE 200
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-3716
Practice Address - Country:US
Practice Address - Phone:318-398-2100
Practice Address - Fax:318-387-7682
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA12029OtherLOUISIANA BOARD OF PHARMACY