SHREVEPORT PHARMACY (2951)    INSTITUTION (4)

Name Value
NAME SHREVEPORT PHARMACY
STATE LOUISIANA
STREET ADDR. 1 510 East Stoner Ave.
CITY Shreveport
ZIP 71101-4243
OFFICIAL VA NAME Shreveport Pharmacy
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME SHREVEPORT VAMC PHARMACY
ST. ADDR. 1 (MAILING) 510 East Stoner Ave.
CITY (MAILING) Shreveport
STATE (MAILING) LOUISIANA
ZIP (MAILING) 71101-4243
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1982652145
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE CENTRAL
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1982652145