Healthcare Provider Details

I. General information

NPI: 1225855265
Provider Name (Legal Business Name): MICAHLYN MONTANA MCKASKLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 HOSPITAL DR
BOSSIER CITY LA
71111-2385
US

IV. Provider business mailing address

1711 WALES LN
BOSSIER CITY LA
71111-5143
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-7320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number024473
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: