Provider Demographics
NPI:1285149690
Name:ARNOLD, JODY OLMSTED (RPH)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:OLMSTED
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:OLMSTED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 MERLOT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-3969
Mailing Address - Country:US
Mailing Address - Phone:337-905-4031
Mailing Address - Fax:
Practice Address - Street 1:1000 WALTERS ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4647
Practice Address - Country:US
Practice Address - Phone:337-480-8273
Practice Address - Fax:337-480-8316
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39408183500000X
LA016829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist