Provider Demographics
NPI:1306160817
Name:KUSTENMACHER, CAROLINE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:KUSTENMACHER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3138
Mailing Address - Country:US
Mailing Address - Phone:985-626-5693
Mailing Address - Fax:985-727-4721
Practice Address - Street 1:3555 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3138
Practice Address - Country:US
Practice Address - Phone:985-626-5693
Practice Address - Fax:985-727-4721
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist