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Individual

NY LE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
13002 COURSEY BLVD, BATON ROUGE, LA 70816-4964
(225) 756-7110
Mailing address
13002 COURSEY BLVD, BATON ROUGE, LA 70816-4964

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.020766
LA

Other

Enumeration date
10/15/2014
Last updated
10/15/2014
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