Healthcare Provider Details

I. General information

NPI: 1346748712
Provider Name (Legal Business Name): JAN MATHERNE LANTRIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29148 SOUTH MONTPELIER AVE
ALBANY LA
70711-0328
US

IV. Provider business mailing address

PO BOX 328
ALBANY LA
70711-0328
US

V. Phone/Fax

Practice location:
  • Phone: 225-567-1921
  • Fax: 225-567-1931
Mailing address:
  • Phone: 225-567-1921
  • Fax: 225-567-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPST.011783
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: