DEREK FONTENOT

LAKE CHARLES, LA
NPI1609311927
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy183500000X Pharmacist
(Licence: LA  PST.021842)
Enumeration Date2016-12-21
Last Update Date2016-12-21
Business Address
-- DEREK FONTENOT
2011 RYAN ST
LAKE CHARLES, LA 70601-7313
Phone number: 337-508-3864
Mailing Address
-- DEREK FONTENOT
1531 COUNTRY CLUB RD APT 511
LAKE CHARLES, LA 70605-5343
Phone number:
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