Individual
EVANS RAY GLASGOW III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4710 JOHNSTON ST, LAFAYETTE, LA 70503-4541
(337) 988-7284
Mailing address
2314 KALISTE SALOOM RD APT 1108, LAFAYETTE, LA 70508-6836
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
022216
LA
Other
Enumeration date
09/21/2017
Last updated
09/21/2017
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