MEDICARE: KALYN ALEXIS LACOMBE 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.024579	LA

General Provider Information

NPI Number	:	1750005021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALYN ALEXIS LACOMBE PHARM.D.

Provider Business Mailing Address
First Line	:	529 OLE HIGHWAY 15 APT 2
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-1911
Country	:	US
Telephone Number	:	318-664-0914
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	:	318-998-3907
Fax Number	:

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

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	09/30/2022

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