Individual
TRA-VI NGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3754 MOSS ST, LAFAYETTE, LA 70507-5537
(337) 269-9300
Mailing address
107 PLAZA VILLAGE DR, LAFAYETTE, LA 70506-6067
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.021781
LA
Other
Enumeration date
10/03/2016
Last updated
10/03/2016
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