Organization
SPECIALISTS HOSPITAL OF SHREVEPORT LLC
Active
Other names
Specialists Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH WILHITE (PHARMACIST IN CHARGE)
(318) 213-3350
Entity
Organization
Contact information
Practice address
1500 LINE AVE, STE #104B, SHREVEPORT, LA 71101-4639
(318) 213-3350
(318) 231-3811
Mailing address
1500 LINE AVE, 104B, SHREVEPORT, LA 71101-4639
(318) 213-3350
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY006385IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2127822
PK
—
Enumeration date
11/11/2010
Last updated
06/22/2016
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