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General NPI Number Information
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NPI Number | 1174538714
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Entity Type | Organization
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Legal Business Name | LANE M ZIMMER
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 2064 W MAIN ST
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City | LUTCHER
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State | LA
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Zip | 70071
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Country | US
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Telephone | 225-869-3535
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Fax | 225-869-8802
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Provider Business Mailing Address
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Address Line | PO BOX 367
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City | LUTCHER
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State | LA
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Zip | 70071-0367
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LANE ZIMMER
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Credential | RPH
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Telephone | 225-869-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY.001129-IR
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License Number State | LA
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