Provider Demographics
NPI:1265663405
Name:GANT, KISHA O'NEAL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KISHA
Middle Name:O'NEAL
Last Name:GANT
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 1:1 DREXEL DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-1056
Mailing Address - Country:US
Mailing Address - Phone:504-520-7436
Mailing Address - Fax:504-520-7971
Practice Address - Street 1:1 DREXEL DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1056
Practice Address - Country:US
Practice Address - Phone:504-520-7436
Practice Address - Fax:504-520-7971
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist