Healthcare Provider Details

I. General information

NPI: 1952957557
Provider Name (Legal Business Name): MEDICATION MANAGEMENT CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 08/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 BEVLY LAKE DR
BOSSIER CITY LA
71111-5174
US

IV. Provider business mailing address

318 BEVLY LAKE DR
BOSSIER CITY LA
71111-5174
US

V. Phone/Fax

Practice location:
  • Phone: 318-331-4466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY UPSHAW
Title or Position: OWNER
Credential: PHARMD
Phone: 318-331-4466