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General NPI Number Information
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NPI Number | 1063638013
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Entity Type | Individual
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Provider Name | LAWRENCE C JUSTICE JR. R.PH.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 1606 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71130-4128
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Country | US
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Telephone | 318-813-1815
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Fax | 318-813-1811
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Provider Business Mailing Address
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Address Line | 3048 LINDHOLM ST
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City | SHREVEPORT
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State | LA
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Zip | 71108-2614
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Country | US
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Telephone | 318-813-1815
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Fax | 318-813-1811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14448
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License Number State | LA
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