Healthcare Provider Details

I. General information

NPI: 1982998191
Provider Name (Legal Business Name): NANCY P EDWARDS R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 QUIMPER PL STE 300
SHREVEPORT LA
71105-5742
US

IV. Provider business mailing address

8720 QUIMPER PL STE 300
SHREVEPORT LA
71105-5742
US

V. Phone/Fax

Practice location:
  • Phone: 318-671-9603
  • Fax: 318-671-1106
Mailing address:
  • Phone: 318-671-9603
  • Fax: 318-671-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number10103
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: