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NPI Code Detail

MEDICARE: JESSICA LUCILLA ROBINSON L.A.T.A

MEDICARE: JESSICA LUCILLA ROBINSON L.A.T.A
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
1183700000XPharmacy Technician2301-0010-2070-662TX

General Provider Information

NPI Number : 1568600252
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LUCILLA ROBINSON L.A.T.A
Provider Business Mailing Address
First Line : 911 BAYOU RESERVE CT
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-9317
Country : US
Telephone Number : 706-464-6814
Fax Number :
Provider Business Practice Location Address
First Line : 602 N ACADIA RD
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-4823
Country : US
Telephone Number : 985-493-4502
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2009
Last Update Date : 03/23/2016

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