Healthcare Provider Details

I. General information

NPI: 1497181283
Provider Name (Legal Business Name): LATASHA M DARENSBOURG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 JEFFERSON HWY
BATON ROUGE LA
70809-1101
US

IV. Provider business mailing address

PO BOX 1587
LULING LA
70070-1587
US

V. Phone/Fax

Practice location:
  • Phone: 225-929-6566
  • Fax: 225-926-9161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020240
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: