Healthcare Provider Details

I. General information

NPI: 1821429465
Provider Name (Legal Business Name): SHANA MURPHY PREJEAN R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 VILLA DR
WESTLAKE LA
70669-5909
US

IV. Provider business mailing address

120 VILLA DR
WESTLAKE LA
70669-5909
US

V. Phone/Fax

Practice location:
  • Phone: 337-304-1120
  • Fax: 337-855-8631
Mailing address:
  • Phone: 337-304-1120
  • Fax: 337-855-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.014355
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: