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NPI Code Detail

MEDICARE: KESA LANE RPH

MEDICARE: KESA LANE RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist15771LA

General Provider Information

NPI Number : 1538475991
Entity Type Code : Individual
Provider Name (Legal Business Name) : KESA LANE RPH
Provider Business Mailing Address
First Line : 610 N PINE ST
Second Line :
City : DERIDDER
State : LA
Zip : 70634-3546
Country : US
Telephone Number : 337-463-7210
Fax Number : 337-462-0930
Provider Business Practice Location Address
First Line : 610 N PINE ST
Second Line :
City : DERIDDER
State : LA
Zip : 70634-3546
Country : US
Telephone Number : 337-463-7210
Fax Number : 337-462-0930
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2010
Last Update Date : 01/14/2020

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Directions to “ KESA LANE RPH” Practice Location

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