Healthcare Provider Details

I. General information

NPI: 1811319304
Provider Name (Legal Business Name): COLLEEN PINDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E FOURTH ST
DEQUINCY LA
70633-3709
US

IV. Provider business mailing address

601 SMITH ST
DEQUINCY LA
70633-3042
US

V. Phone/Fax

Practice location:
  • Phone: 337-786-4004
  • Fax: 337-786-4005
Mailing address:
  • Phone: 337-786-4004
  • Fax: 337-786-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10285
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: