Provider Demographics
NPI:1962785196
Name:LANDRY, ROBERT ALEXANDER (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:LANDRY
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 1:24042 SNOWY EGRET CV
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:70462-8091
Mailing Address - Country:US
Mailing Address - Phone:985-510-1226
Mailing Address - Fax:
Practice Address - Street 1:285 W PINE ST
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-3310
Practice Address - Country:US
Practice Address - Phone:985-386-6132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist