MEDICARE: JESSICA PETE PHARM.D.

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	019423	LA

General Provider Information

NPI Number	:	1376099143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PETE PHARM.D.

Provider Business Mailing Address
First Line	:	2818 BARB LANE
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2818 BARB LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-7645
Country	:	US
Telephone Number	:	337-842-4335
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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