MEDICARE: GEORGE LOCK PARET III RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11073	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11073	OTHER	LA	PHARMACIST

General Provider Information

NPI Number	:	1356341390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE LOCK PARET III RPH

Provider Business Mailing Address
First Line	:	2716 LAKE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8216
Country	:	US
Telephone Number	:	337-477-7115
Fax Number	:	337-477-7126

Provider Business Practice Location Address
First Line	:	2716 LAKE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8216
Country	:	US
Telephone Number	:	337-477-7115
Fax Number	:	337-477-7126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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