Organization
LINE AVENUE PHARMACY INC
Active
Other names
Shreveport Nuclear Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN RANDALL CAUDLE PD (PRESIDENT/OWNER)
(318) 221-5114
Entity
Organization
Contact information
Practice address
1822 LINE AVE, SHREVEPORT, LA 71101-4612
(318) 221-5114
(318) 221-5137
Mailing address
1822 LINE AVE, SHREVEPORT, LA 71101-4612
(318) 221-5114
(318) 221-5137
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
LA 3999-IR
LA
3336N0007X
Nuclear Pharmacy
Primary
LA 4001-NU
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1266841
—
LA
Enumeration date
10/18/2006
Last updated
09/11/2025
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