Individual
NHI LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11430 FLORIDA BLVD, BATON ROUGE, LA 70815-2403
(225) 275-3076
Mailing address
12825 KING JOHN PL, BATON ROUGE, LA 70815-6433
(225) 252-4813
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
021689
LA
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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