| Doctor Name: | LYLE BULGER |
| NPI Number: | 1033464714 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARMACIST |
| License Number: | 8889 |
| Business Practice Address: | 1635 Hwy 3125 Gramercy, LA - 70052 |
| Business Phone Number: | 2258693651 |
| Business Fax Number: | 2259688826 |
| Mailing Address: | 1635 Hwy 3125, P.o. Box 1511 GRAMERCY |
| State: | LA |
| Postal Code: | 70052 |
| Phone Number: | 2258693651 |
| Fax Number: | 2259688826 |
| NPI Enumeration Date: | 07/18/2012 |
| NPI Last Update Date: | 07/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835N1003X |
| License Number: | 8889 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Nutrition Support |
| Taxonomy Definition: | A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs. |