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Individual

KESA LANE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RPH

Contact information

Practice address
610 N PINE ST, DERIDDER, LA 70634-3546
(337) 463-7210
(337) 462-0930
Mailing address
610 N PINE ST, DERIDDER, LA 70634-3546
(337) 463-7210
(337) 462-0930

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15771
LA

Other

Enumeration date
08/24/2010
Last updated
01/14/2020
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