Provider Demographics
NPI:1003930959
Name:LANCON, CAROLYN P (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:P
Last Name:LANCON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 STANFORD AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3667
Mailing Address - Country:US
Mailing Address - Phone:225-252-0193
Mailing Address - Fax:
Practice Address - Street 1:2001 S BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4638
Practice Address - Country:US
Practice Address - Phone:225-644-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist