Healthcare Provider Details

I. General information

NPI: 1053628362
Provider Name (Legal Business Name): JONATHAN LEMOINE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TOWER DR STE 102
MONROE LA
71201-5783
US

IV. Provider business mailing address

2600 TOWER DR STE 102
MONROE LA
71201-5783
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-6293
  • Fax:
Mailing address:
  • Phone: 318-966-6293
  • Fax: 318-966-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16019
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: