Healthcare Provider Details

I. General information

NPI: 1144708520
Provider Name (Legal Business Name): CASSIE LORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKSHIRES 7920 DESIARD STREET
MONROE LA
71203
US

IV. Provider business mailing address

63 BENNETT LN
RAYVILLE LA
71269-5508
US

V. Phone/Fax

Practice location:
  • Phone: 318-343-1284
  • Fax:
Mailing address:
  • Phone: 870-500-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022493
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: