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General NPI Number Information
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NPI Number | 1255118675
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Entity Type | Individual
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Provider Name | KEELEY RICHARD LABORDE
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Gender | Female
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 2495 SHREVEPORT HWY
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City | PINEVILLE
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State | LA
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Zip | 71360-4044
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Country | US
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Telephone | 800-375-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 1829 MAIN HWY # 31
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City | ARNAUDVILLE
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State | LA
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Zip | 70512-4116
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Country | US
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Telephone | 337-412-1092
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Fax |
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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 | PST.024949
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License Number State | LA
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