Healthcare Provider Details

I. General information

NPI: 1003848151
Provider Name (Legal Business Name): JOHN EDWARD ZITZMANN III R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MCMILLAN RD
WEST MONROE LA
71291-5327
US

IV. Provider business mailing address

202 COMANCHE TRL
WEST MONROE LA
71291-8108
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-4643
  • Fax: 318-329-4647
Mailing address:
  • Phone: 318-396-3679
  • Fax: 318-329-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9992
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: