Healthcare Provider Details

I. General information

NPI: 1720994890
Provider Name (Legal Business Name): CAMDEN CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 BARKSDALE BLVD
BOSSIER CITY LA
71112-3902
US

IV. Provider business mailing address

8455 FERN AVE APT 1808
SHREVEPORT LA
71105-5789
US

V. Phone/Fax

Practice location:
  • Phone: 318-606-6305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.026358
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: