Healthcare Provider Details

I. General information

NPI: 1568865053
Provider Name (Legal Business Name): KRISTEN UKPAKA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 YOUREE DR
SHREVEPORT LA
71105-2116
US

IV. Provider business mailing address

3300 YOUREE DR
SHREVEPORT LA
71105-2116
US

V. Phone/Fax

Practice location:
  • Phone: 318-869-3453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020315
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: