Individual
WYLIE LEE SHORES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
745 SHREVEPORT BARKSDALE HWY, SHREVEPORT, LA 71105-2201
(318) 861-3985
Mailing address
6145 RIPPLEWOOD DR, SHREVEPORT, LA 71107-9586
(318) 518-0359
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13028
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13028
PHARMACY LICENSE
LA
Enumeration date
09/15/2010
Last updated
09/15/2010
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