Provider Demographics
NPI:1982912499
Name:LIGHTFOOT, ALLISON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-0228
Mailing Address - Country:US
Mailing Address - Phone:337-856-5761
Mailing Address - Fax:337-856-8382
Practice Address - Street 1:601 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592
Practice Address - Country:US
Practice Address - Phone:337-856-5761
Practice Address - Fax:337-856-8382
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA89654Medicaid