Individual
STACY WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
3400 AIRLINE DR, BOSSIER CITY, LA 71111-2122
(318) 741-6589
(318) 741-6675
Mailing address
3400 AIRLINE DR, BOSSIER CITY, LA 71111-2122
(318) 741-6589
(318) 741-6675
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16748
LA
Other
Enumeration date
08/17/2010
Last updated
08/17/2010
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