Provider Demographics
NPI:1265705297
Name:MONTECINO, DOUGLAS CHRISTOPHER (RPH)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:CHRISTOPHER
Last Name:MONTECINO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3746
Mailing Address - Country:US
Mailing Address - Phone:504-343-4822
Mailing Address - Fax:
Practice Address - Street 1:1524 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3723
Practice Address - Country:US
Practice Address - Phone:337-828-3392
Practice Address - Fax:337-828-3414
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist