MEDICARE: CHLOE S MONTGOMERY

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.022575	LA

General Provider Information

NPI Number	:	1760961015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHLOE S MONTGOMERY

Provider Business Mailing Address
First Line	:	30399 SAINT JOHN DR
Second Line	:
City	:	LACOMBE
State	:	LA
Zip	:	70445-2859
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 FLORIDA ST
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70448-5234
Country	:	US
Telephone Number	:	985-951-7282
Fax Number	:

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

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	08/08/2018

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Directions to “ CHLOE S MONTGOMERY ” Practice Location

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