Healthcare Provider Details

I. General information

NPI: 1619898608
Provider Name (Legal Business Name): RICHARD LACOURSIERE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MICHIGAN ST
SOUTH BEND IN
46601-1087
US

IV. Provider business mailing address

61637 MIAMI MEADOWS CT
SOUTH BEND IN
46614-5772
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-1000
  • Fax:
Mailing address:
  • Phone: 574-647-6427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number26031030A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: