Provider Demographics
NPI:1386868735
Name:JEANE, KIRKLAND DANIEL (RPH)
Entity type:Individual
Prefix:MR
First Name:KIRKLAND
Middle Name:DANIEL
Last Name:JEANE
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 1:31009 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-8501
Mailing Address - Country:US
Mailing Address - Phone:225-271-8416
Mailing Address - Fax:
Practice Address - Street 1:31009 DUNN RD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-8501
Practice Address - Country:US
Practice Address - Phone:225-271-8416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202013142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist