Healthcare Provider Details

I. General information

NPI: 1841072907
Provider Name (Legal Business Name): MICHAEL JUDE LYTELL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 HIGHWAY 22
MANDEVILLE LA
70471-3317
US

IV. Provider business mailing address

69444 TAVERNY CT
MADISONVILLE LA
70447-3207
US

V. Phone/Fax

Practice location:
  • Phone: 985-674-2551
  • Fax:
Mailing address:
  • Phone: 504-338-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.025034
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: