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Individual

DR. MICHELLE C VAULTZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
12881 PERKINS RD, BATON ROUGE, LA 70810-1913
(225) 763-6281
Mailing address
12881 PERKINS RD, BATON ROUGE, LA 70810-1913
(225) 763-6281

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
20027
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
20027
IMMUNIZER
LA
Enumeration date
09/16/2014
Last updated
09/16/2014
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