Healthcare Provider Details

I. General information

NPI: 1356903421
Provider Name (Legal Business Name): WILLIAM BRANDON POOLE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11973 HWY 84 W
JENA LA
71342-7134
US

IV. Provider business mailing address

PO BOX 589
JENA LA
71342-0589
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-5565
  • Fax: 318-992-5599
Mailing address:
  • Phone: 318-992-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17751
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: