MEDICARE: LAUREN M'LYN BLACKWELL PHARMD

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	022120	LA

General Provider Information

NPI Number	:	1609445089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN M'LYN BLACKWELL PHARMD

Provider Business Mailing Address
First Line	:	130 DESIARD ST STE 300
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-7363
Country	:	US
Telephone Number	:	318-361-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 DESIARD ST STE 300
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-7363
Country	:	US
Telephone Number	:	318-361-0900
Fax Number	:

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

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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