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General NPI Number Information
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NPI Number | 1326557406
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Entity Type | Individual
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Provider Name | JACOB LANE GUICHET PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 09/21/2017
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Provider Practice Location Address
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Address Line | 6300 MAIN ST
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City | ZACHARY
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State | LA
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Zip | 70791-4037
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Country | US
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Telephone | 225-658-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 5475 BOULEVARD D ISLE
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City | JARREAU
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State | LA
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Zip | 70749-3119
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Country | US
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Telephone | 225-718-8323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PST.022219
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License Number State | LA
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