Individual
MIRANDA DEJEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1315 MOSS ST, LAFAYETTE, LA 70501-3648
(337) 232-1564
Mailing address
1315 MOSS ST, LAFAYETTE, LA 70501-3648
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
021780
LA
Other
Enumeration date
10/03/2016
Last updated
10/03/2016
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