Individual
MR. PAUL ROLAND PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
804 ROBERT LEE CIR, LAFAYETTE, LA 70506-3143
(337) 654-9777
Mailing address
804 ROBERT LEE CIR, LAFAYETTE, LA 70506-3143
(337) 654-9777
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14331
LA
Other
Enumeration date
09/16/2011
Last updated
09/16/2011
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