Individual
LAN P VO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1108 E MAIN ST, NEW IBERIA, LA 70560-3920
(337) 365-4514
Mailing address
508 S LEWIS ST, NEW IBERIA, LA 70560-4819
(404) 664-8659
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13034
LA
Other
Enumeration date
03/15/2011
Last updated
03/15/2011
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