Provider Demographics
NPI:1033464714
Name:BULGER, LYLE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:
Last Name:BULGER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 HWY 3125
Mailing Address - Street 2:P.O. BOX 1511
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052
Mailing Address - Country:US
Mailing Address - Phone:225-869-3651
Mailing Address - Fax:225-968-8826
Practice Address - Street 1:1635 HWY 3125
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052
Practice Address - Country:US
Practice Address - Phone:225-869-3651
Practice Address - Fax:225-968-8826
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA88891835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1917939OtherNABP