MEDICARE: ANITA RAHMAN

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	64145	TX
2	183500000X	Pharmacist	PST.022645	LA

General Provider Information

NPI Number	:	1336705235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA RAHMAN

Provider Business Mailing Address
First Line	:	5351 E CRESTVIEW DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5278
Country	:	US
Telephone Number	:	337-540-2624
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 COUNTRY CLUB RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5206
Country	:	US
Telephone Number	:	337-990-4901
Fax Number	:

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

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	05/15/2019

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Directions to “ ANITA RAHMAN ” Practice Location

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