Provider Demographics
NPI:1952099038
Name:LABATUT, MARY ELIZABETH (PST013632)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:LABATUT
Suffix:
Gender:F
Credentials:PST013632
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:LABATUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:7717 LA HIGHWAY 418
Mailing Address - Street 2:
Mailing Address - City:BATCHELOR
Mailing Address - State:LA
Mailing Address - Zip Code:70715-3415
Mailing Address - Country:US
Mailing Address - Phone:225-718-3984
Mailing Address - Fax:225-655-2725
Practice Address - Street 1:17544 TUNICA TRCE
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:LA
Practice Address - Zip Code:70712-3029
Practice Address - Country:US
Practice Address - Phone:225-655-2307
Practice Address - Fax:225-655-2725
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.013632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist