Provider Demographics
NPI:1053806257
Name:LANTIER, LARRY (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:LANTIER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6340
Mailing Address - Country:US
Mailing Address - Phone:337-322-7383
Mailing Address - Fax:337-233-3385
Practice Address - Street 1:5900 CAMERON STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583
Practice Address - Country:US
Practice Address - Phone:337-233-3382
Practice Address - Fax:337-233-3385
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1233935Medicaid