Provider Demographics
NPI:1962870949
Name:MUMPHREY, LANEKA
Entity type:Individual
Prefix:
First Name:LANEKA
Middle Name:
Last Name:MUMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8163 JONES ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:LA
Mailing Address - Zip Code:70086-7521
Mailing Address - Country:US
Mailing Address - Phone:225-717-2303
Mailing Address - Fax:
Practice Address - Street 1:1435 W. TUNNEL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-223-2945
Practice Address - Fax:985-223-8975
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-14128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist