Provider Demographics
NPI:1962717199
Name:CHEDOTAL, REBECCA (PHARMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CHEDOTAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2947
Mailing Address - Country:US
Mailing Address - Phone:985-345-1600
Mailing Address - Fax:985-345-9991
Practice Address - Street 1:1910 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2947
Practice Address - Country:US
Practice Address - Phone:985-345-1600
Practice Address - Fax:985-345-9991
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist