Healthcare Provider Details

I. General information

NPI: 1295639300
Provider Name (Legal Business Name): JACQUELINE DAHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15929 AIRLINE HWY
BATON ROUGE LA
70817-7448
US

IV. Provider business mailing address

5918 WESTRIDGE DR
BATON ROUGE LA
70817-2863
US

V. Phone/Fax

Practice location:
  • Phone: 225-752-2159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.026458
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: