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General NPI Number Information
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NPI Number | 1750020053
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Entity Type | Organization
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Legal Business Name | CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 8730 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71115-2500
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Country | US
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Telephone | 318-408-1508
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Fax | 318-408-1509
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Provider Business Mailing Address
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Address Line | PO BOX 66156
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City | BATON ROUGE
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State | LA
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Zip | 70896-6156
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Country | US
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Telephone | 225-650-2000
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MAIMOUNA KEITA
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Credential |
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Telephone | 225-650-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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