Provider Demographics
NPI:1679876288
Name:TORRES, KEVIN WILLIAM JR (PHARMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:WILLIAM
Last Name:TORRES
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42413 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2182
Mailing Address - Country:US
Mailing Address - Phone:225-294-6164
Mailing Address - Fax:
Practice Address - Street 1:1812 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2945
Practice Address - Country:US
Practice Address - Phone:985-345-4767
Practice Address - Fax:985-345-4768
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.016947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2105779Medicaid