Individual
MICHAEL WAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1514 JEFFERSON HWY, JEFFERSON, LA 70121-2429
(256) 226-6787
Mailing address
1514 JEFFERSON HWY, JEFFERSON, LA 70121-2429
(334) 844-8348
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.025847
LA
Other
Enumeration date
01/26/2023
Last updated
12/29/2025
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