Healthcare Provider Details

I. General information

NPI: 1730013327
Provider Name (Legal Business Name): CLAY R LASSITER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 FLOYD ST
BUNKIE LA
71322-1602
US

IV. Provider business mailing address

302 FLOYD ST
BUNKIE LA
71322-1602
US

V. Phone/Fax

Practice location:
  • Phone: 318-616-1946
  • Fax:
Mailing address:
  • Phone: 318-616-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number149595
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: