Individual
KELLY PAUL MARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1401 REES ST, BREAUX BRIDGE, LA 70517-4307
(337) 507-3810
Mailing address
1098 LATIOLAIS LOOP, BREAUX BRIDGE, LA 70517-7921
(337) 228-7490
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.019978
LA
Other
Enumeration date
10/23/2012
Last updated
10/23/2012
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