Provider Demographics
NPI:1932358702
Name:PUCHEU, PHILIPPE EMILE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PHILIPPE
Middle Name:EMILE
Last Name:PUCHEU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83352
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-3352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-492-1480
Practice Address - Street 1:10101 PARK ROWE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1686
Practice Address - Country:US
Practice Address - Phone:225-906-4961
Practice Address - Fax:225-906-4829
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1896616Medicaid