MEDICARE: ALEXIS GOSSERAND

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	021132	LA

General Provider Information

NPI Number	:	1811379241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS GOSSERAND

Provider Business Mailing Address
First Line	:	13555 OLD HAMMOND HWY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-1161
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13555 OLD HAMMOND HWY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-1161
Country	:	US
Telephone Number	:	225-272-8566
Fax Number	:

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

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	07/28/2015

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