Provider Demographics
NPI:1629415161
Name:PLAUCHE, LYLE WILLIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:WILLIAM
Last Name:PLAUCHE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17856 GRAY MOSS AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1737
Mailing Address - Country:US
Mailing Address - Phone:225-603-6047
Mailing Address - Fax:
Practice Address - Street 1:17856 GRAY MOSS AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1737
Practice Address - Country:US
Practice Address - Phone:225-603-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.019760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist