Healthcare Provider Details

I. General information

NPI: 1659980282
Provider Name (Legal Business Name): CARLEIGH ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 LOUISVILLE AVE
MONROE LA
71201-6658
US

IV. Provider business mailing address

5732 HIGHWAY 15
FARMERVILLE LA
71241-8364
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-8698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.023496
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: