Provider Demographics
NPI:1942592373
Name:LACOUR, BERNARD KEVIN (DPH)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:KEVIN
Last Name:LACOUR
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9016 RIVER KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0687
Mailing Address - Country:US
Mailing Address - Phone:901-624-5606
Mailing Address - Fax:
Practice Address - Street 1:9016 RIVER KNOLL DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0687
Practice Address - Country:US
Practice Address - Phone:901-624-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist