Individual
LYNSIE FULKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1701 OAK PARK BLVD, LAKE CHARLES, LA 70601-8911
(337) 494-3180
Mailing address
1015 ARTHUR BOURGEOIS RD, KAPLAN, LA 70548-5274
(337) 652-1596
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.023626
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PST.023626
LOUISIANA BOARD OF PHARMACY
LA
Enumeration date
12/07/2020
Last updated
12/07/2020
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