Individual
EDWARD GLENN BERNATOWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(318) 212-4170
Mailing address
317 WILD OAK DR, SHREVEPORT, LA 71106-8227
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
PST.010749
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PST.010749
LOUISIANA STATE PHARMACIST LICENSE NUMBER
LA
Enumeration date
10/13/2016
Last updated
10/13/2016
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