MEDICARE: LISA LOUNSBERRY 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	15394	LA

General Provider Information

NPI Number	:	1659190361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LOUNSBERRY PHARMD

Provider Business Mailing Address
First Line	:	1717 OAK PARK BLVD STE 110
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8977
Country	:	US
Telephone Number	:	337-494-2990
Fax Number	:	337-494-2550

Provider Business Practice Location Address
First Line	:	1717 OAK PARK BLVD STE 110
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8977
Country	:	US
Telephone Number	:	337-494-2990
Fax Number	:	337-494-2550

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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