MEDICARE: MADELINE 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
1	183500000X	Pharmacist	021729	LA

General Provider Information

NPI Number	:	1407308034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE LANDRY

Provider Business Mailing Address
First Line	:	3731 INWOOD DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-6770
Country	:	US
Telephone Number	:	337-377-9638
Fax Number	:

Provider Business Practice Location Address
First Line	:	3731 INWOOD DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-6770
Country	:	US
Telephone Number	:	337-377-9638
Fax Number	:

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

Provider Enumeration Date	:	10/31/2016
Last Update Date	:	10/31/2016

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Directions to “ MADELINE LANDRY ” Practice Location

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