Provider Demographics
NPI:1750005021
Name:LACOMBE, KALYN ALEXIS (PHARMD)
Entity type:Individual
Prefix:
First Name:KALYN
Middle Name:ALEXIS
Last Name:LACOMBE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 OLE HIGHWAY 15 APT 2
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1911
Mailing Address - Country:US
Mailing Address - Phone:318-664-0914
Mailing Address - Fax:
Practice Address - Street 1:130 DESIARD ST STE 300
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7363
Practice Address - Country:US
Practice Address - Phone:318-998-3907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist