Provider Demographics
NPI:1609208578
Name:CAVALIER, JASON GEORGE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GEORGE
Last Name:CAVALIER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2678 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3240
Mailing Address - Country:US
Mailing Address - Phone:337-233-2940
Mailing Address - Fax:
Practice Address - Street 1:2678 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3240
Practice Address - Country:US
Practice Address - Phone:337-233-2265
Practice Address - Fax:337-233-4183
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3853281Medicaid