Provider Demographics
NPI:1962784132
Name:ARCENEAUX, BRYAN NEIL
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:NEIL
Last Name:ARCENEAUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3907
Mailing Address - Country:US
Mailing Address - Phone:337-984-3711
Mailing Address - Fax:
Practice Address - Street 1:1326 W PINHOOK RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2900
Practice Address - Country:US
Practice Address - Phone:337-235-9197
Practice Address - Fax:337-235-9198
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist