Healthcare Provider Details

I. General information

NPI: 1790061661
Provider Name (Legal Business Name): JARED OCMAND PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 GREENWOOD RD SUITE 110
SHREVEPORT LA
71103-3981
US

IV. Provider business mailing address

2551 GREENWOOD RD SUITE 110
SHREVEPORT LA
71103-3981
US

V. Phone/Fax

Practice location:
  • Phone: 318-631-2005
  • Fax: 318-631-1883
Mailing address:
  • Phone: 318-631-2005
  • Fax: 318-631-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19101
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: