MEDICARE: DR. MATTHEW LAY 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	PST.019802	LA

General Provider Information

NPI Number	:	1508264599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW LAY PHARM. D

Provider Business Mailing Address
First Line	:	2403 ARKANSAS RD
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-8611
Country	:	US
Telephone Number	:	318-396-1812
Fax Number	:

Provider Business Practice Location Address
First Line	:	2403 ARKANSAS RD
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-8611
Country	:	US
Telephone Number	:	318-396-1812
Fax Number	:

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

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	12/08/2014

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