MEDICARE: MRS. JENA FACIANE

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
1	183500000X	Pharmacist	017707	LA

General Provider Information

NPI Number	:	1295147130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENA FACIANE

Provider Business Mailing Address
First Line	:	500 LAFAYETTE ST
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70053-5936
Country	:	US
Telephone Number	:	504-252-9686
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 LAFAYETTE ST
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70053-5936
Country	:	US
Telephone Number	:	504-252-9686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	05/27/2014

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Directions to “ MRS. JENA FACIANE ” Practice Location

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