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Individual

ACE DO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
14444 COURSEY BLVD, BATON ROUGE, LA 70817-1319
(225) 753-1499
Mailing address
13504 ASHBY AVE, BATON ROUGE, LA 70815-7258
(715) 529-0941

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-100381
MS

Other

Enumeration date
09/15/2021
Last updated
09/15/2021
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