Healthcare Provider Details

I. General information

NPI: 1902202328
Provider Name (Legal Business Name): JANICE HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TOWER DR SUITE 102
MONROE LA
71201-5766
US

IV. Provider business mailing address

113 PARKWOOD BLVD
WEST MONROE LA
71292-2196
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-6290
  • Fax: 318-966-6294
Mailing address:
  • Phone: 318-348-1263
  • Fax: 318-966-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11656
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: