Basic Information
| Provider Information | |||||||||
| NPI: | 1801849682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOREAU | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DAMIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH/PD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1915 TEXAS AVE | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713013930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187301363 | ||||||||
| FaxNumber: | 3184835013 | ||||||||
| Practice Location | |||||||||
| Address1: | 2495 SHREVEPORT HWY # 71 | ||||||||
| Address2: | |||||||||
| City: | PINEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713604044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184662574 | ||||||||
| FaxNumber: | 3184835013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 14417 | LA | N | Pharmacy Service Providers | Pharmacist | 1835P1200X | 14417 | LA | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P0018X | 14417 | LA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.