Individual
HARRISON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4430 DESIARD ST, MONROE, LA 71203-4532
(318) 267-3609
(318) 267-3610
Mailing address
4430 DESIARD ST, MONROE, LA 71203-4532
(318) 267-3609
(318) 267-3610
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PD15843
AR
183500000X
Pharmacist
Primary
PST.023939
LA
Other
Enumeration date
07/16/2021
Last updated
10/29/2025
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