Provider Demographics
NPI:1548834005
Name:LANINGHAM, BRYCE (PHARM D)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:LANINGHAM
Suffix:
Gender:M
Credentials:PHARM D
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 636
Mailing Address - Street 2:
Mailing Address - City:BERNICE
Mailing Address - State:LA
Mailing Address - Zip Code:71222-0636
Mailing Address - Country:US
Mailing Address - Phone:318-285-9521
Mailing Address - Fax:
Practice Address - Street 1:417 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BERNICE
Practice Address - State:LA
Practice Address - Zip Code:71222
Practice Address - Country:US
Practice Address - Phone:318-285-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist