Healthcare Provider Details

I. General information

NPI: 1992203590
Provider Name (Legal Business Name): LESTER ROAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 S ARKANSAS ST
SPRINGHILL LA
71075-4320
US

IV. Provider business mailing address

1920 S ARKANSAS ST
SPRINGHILL LA
71075-4320
US

V. Phone/Fax

Practice location:
  • Phone: 318-539-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010072
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: