Individual
MR. GLENN JOSEPH FAUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4313 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70508-6703
(337) 981-9673
Mailing address
4313 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70508-6703
(337) 981-9673
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11870
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1269735
—
LA
Enumeration date
07/01/2011
Last updated
07/01/2011
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