Individual
BRIAN ETHAN JAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
3333 MASONIC DR, ALEXANDRIA, LA 71301-3842
(318) 445-6386
Mailing address
2705 PINE LAKE DR APT 2705, PINEVILLE, LA 71360-5865
(858) 837-4620
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.022336
LA
Other
Enumeration date
01/08/2018
Last updated
03/17/2018
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