Individual
LADERA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6235 WESTPORT AVE, SHREVEPORT, LA 71129-2503
(318) 688-7705
Mailing address
6235 WESTPORT AVE, SHREVEPORT, LA 71129-2503
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18259
LA
Other
Enumeration date
03/12/2014
Last updated
03/12/2014
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