Provider Demographics
NPI:1962406629
Name:MISURACA, CHAD JOSEPH (RPH)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:JOSEPH
Last Name:MISURACA
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 1:7014 HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-7346
Mailing Address - Country:US
Mailing Address - Phone:318-352-3141
Mailing Address - Fax:318-357-0976
Practice Address - Street 1:407 BIENVILLE ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5702
Practice Address - Country:US
Practice Address - Phone:318-352-3141
Practice Address - Fax:318-357-0976
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist