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Individual

JACOB ELIE BERGERON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARM.D.

Contact information

Practice address
4710 JOHNSTON ST, LAFAYETTE, LA 70503-4541
(337) 988-7284
Mailing address
4710 JOHNSTON ST, LAFAYETTE, LA 70503-4541
(337) 988-7284

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
45939
LA

Other

Enumeration date
05/15/2012
Last updated
05/15/2012
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