Individual
JEREMY RANDALL MOFFETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7110 YOUREE DR, SHREVEPORT, LA 71105-5107
(318) 798-7860
Mailing address
151 WATERS EDGE DR, SHREVEPORT, LA 71106-7775
(318) 798-6593
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16563
LA
Other
Enumeration date
06/11/2011
Last updated
06/11/2011
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