Healthcare Provider Details

I. General information

NPI: 1205780285
Provider Name (Legal Business Name): SHELBY TAYLOR JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 AIRLINE DR
BOSSIER CITY LA
71111-6609
US

IV. Provider business mailing address

4860 AIRLINE DR
BOSSIER CITY LA
71111-6609
US

V. Phone/Fax

Practice location:
  • Phone: 318-584-7433
  • Fax: 318-584-7434
Mailing address:
  • Phone: 318-584-7433
  • Fax: 318-584-7434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.025582
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: