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General NPI Number Information
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NPI Number | 1942924287
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Entity Type | Individual
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Provider Name | DESTINY DUBOSE PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 2640 WAGGONER AVE
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City | SHREVEPORT
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State | LA
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Zip | 71108-3859
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Country | US
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Telephone | 318-631-2065
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 RIVER PARKWAY BLVD APT 910
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City | SHREVEPORT
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State | LA
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Zip | 71104-1821
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Country | US
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Telephone | 318-355-0331
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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 | 024575
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License Number State | LA
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