Individual
RENICE REBECCA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3341 YOUREE DR STE 205, SHREVEPORT, LA 71105-2149
(318) 219-4167
Mailing address
3341 YOUREE DR STE 205, SHREVEPORT, LA 71105-2149
(318) 219-4167
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
009189
LA
Other
Enumeration date
10/21/2019
Last updated
10/21/2019
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