Healthcare Provider Details

I. General information

NPI: 1730209164
Provider Name (Legal Business Name): KATHY E DENMAN PHARMACY-TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 DAVENPORT AVE.
MER ROUGE LA
71261
US

IV. Provider business mailing address

12714 HORSESHOE LAKE RD
MER ROUGE LA
71261-8707
US

V. Phone/Fax

Practice location:
  • Phone: 318-647-5754
  • Fax: 318-647-5222
Mailing address:
  • Phone: 318-647-3316
  • Fax: 318-647-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2260
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: