Provider Demographics
NPI:1356520126
Name:CLOUTIER, MARC EDWARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:EDWARD
Last Name:CLOUTIER
Suffix:
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 1:3030 GOLIAD RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3959
Mailing Address - Country:US
Mailing Address - Phone:210-359-6949
Mailing Address - Fax:210-359-6765
Practice Address - Street 1:3030 GOLIAD RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3959
Practice Address - Country:US
Practice Address - Phone:210-359-6949
Practice Address - Fax:210-359-6765
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist