Provider Demographics
NPI:1225245152
Name:BROWN, KANISHA KANTRELLE (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:KANISHA
Middle Name:KANTRELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MOSS DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6452
Mailing Address - Country:US
Mailing Address - Phone:985-652-8972
Mailing Address - Fax:
Practice Address - Street 1:712 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:WESTWEGO
Practice Address - State:LA
Practice Address - Zip Code:70094-4400
Practice Address - Country:US
Practice Address - Phone:504-340-1110
Practice Address - Fax:504-340-5188
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist