Provider Demographics
NPI:1366759755
Name:MARCANTEL, CHRISTINA GAYLE
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:GAYLE
Last Name:MARCANTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-4320
Mailing Address - Country:US
Mailing Address - Phone:337-457-5216
Mailing Address - Fax:337-457-0920
Practice Address - Street 1:1200 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-4320
Practice Address - Country:US
Practice Address - Phone:337-457-5216
Practice Address - Fax:337-457-0920
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1894460Medicaid