Organization
BRFHH SHREVEPORT LLC
Active
Other names
University Health Shreveport
Organization subpart
No
Provider details
NPI number
Authorized official
JASON LAFITTE (DIRECTOR)
(318) 675-5248
Entity
Organization
Contact information
Practice address
1541 KINGS HWY RM EG-10, SHREVEPORT, LA 71103-4228
(318) 675-3364
(318) 675-4369
Mailing address
1541 KINGS HWY, RM EG-10, SHREVEPORT, LA 71103-4228
(318) 675-3364
(318) 675-4369
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY007202IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1737712
—
LA
01
—
2154847
PK
—
Enumeration date
10/29/2015
Last updated
11/20/2015
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