Individual
MICHAEL M PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
755 OLE HIGHWAY 15 LOT 92, WEST MONROE, LA 71291-1413
(318) 680-3590
Mailing address
755 OLE HIGHWAY 15 LOT 92, WEST MONROE, LA 71291-1413
(318) 680-3590
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15527
LA
Other
Enumeration date
09/20/2011
Last updated
09/20/2011
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