Provider Demographics
NPI:1306929898
Name:CLOESSNER, MARTIN ELDRIDGE JR (RPH)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ELDRIDGE
Last Name:CLOESSNER
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:1825 EAST OAK ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-0940
Mailing Address - Country:US
Mailing Address - Phone:318-992-5088
Mailing Address - Fax:318-992-6446
Practice Address - Street 1:1825 EAST OAK ST
Practice Address - Street 2:SUITE A
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-0940
Practice Address - Country:US
Practice Address - Phone:318-992-5088
Practice Address - Fax:318-992-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA93591835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy