Individual
DAMON COUSIN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2078 WOODMERE BLVD, HARVEY, LA 70058-2245
(504) 322-7466
Mailing address
PO BOX 2231, SLIDELL, LA 70459-2231
(985) 445-3154
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15422
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTHER
OTHER
LA
Enumeration date
11/05/2021
Last updated
11/05/2021
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