Provider Demographics
NPI:1841072907
Name:LYTELL, MICHAEL JUDE (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUDE
Last Name:LYTELL
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 1:69444 TAVERNY CT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3207
Mailing Address - Country:US
Mailing Address - Phone:504-338-4446
Mailing Address - Fax:
Practice Address - Street 1:4330 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3317
Practice Address - Country:US
Practice Address - Phone:985-674-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.025034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist