Healthcare Provider Details

I. General information

NPI: 1790651057
Provider Name (Legal Business Name): KELLIE LEAANNE BELGARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9465 HIGHWAY 165
POLLOCK LA
71467-3511
US

IV. Provider business mailing address

9465 HIGHWAY 165
POLLOCK LA
71467-3511
US

V. Phone/Fax

Practice location:
  • Phone: 318-310-2070
  • Fax: 318-310-2512
Mailing address:
  • Phone: 318-310-2070
  • Fax: 318-310-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025387
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: