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NPI Code Detail

MEDICARE: JONATHAN MATTHEW LANDRY

MEDICARE: JONATHAN MATTHEW LANDRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPST.023104LA

General Provider Information

NPI Number : 1245885698
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN MATTHEW LANDRY
Provider Business Mailing Address
First Line : 103 E MAIN ST
Second Line :
City : BROUSSARD
State : LA
Zip : 70518-4616
Country : US
Telephone Number : 337-839-8880
Fax Number : 337-839-8881
Provider Business Practice Location Address
First Line : 103 E MAIN ST
Second Line :
City : BROUSSARD
State : LA
Zip : 70518-4616
Country : US
Telephone Number : 337-839-8880
Fax Number : 337-839-8881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2019
Last Update Date : 08/02/2019

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Directions to “ JONATHAN MATTHEW LANDRY ” Practice Location

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