Individual
EBONY FAULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2252 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70506-3705
(337) 780-7745
Mailing address
2252 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70506-3705
(337) 780-7745
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.021648
LA
Other
Enumeration date
08/07/2016
Last updated
08/07/2016
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