Provider Demographics
NPI:1033493697
Name:LACOMBE, MERLIN ANTHONY JR
Entity Type:Individual
Prefix:MR
First Name:MERLIN
Middle Name:ANTHONY
Last Name:LACOMBE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 BERTRAND DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5546
Mailing Address - Country:US
Mailing Address - Phone:337-232-7380
Mailing Address - Fax:
Practice Address - Street 1:705 BERTRAND DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5546
Practice Address - Country:US
Practice Address - Phone:337-232-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist