Provider Demographics
NPI:1316358526
Name:BOSWORTH, JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:BOSWORTH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:LA
Mailing Address - Zip Code:70374
Mailing Address - Country:US
Mailing Address - Phone:985-532-2545
Mailing Address - Fax:985-532-5567
Practice Address - Street 1:1428 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:LA
Practice Address - Zip Code:70374
Practice Address - Country:US
Practice Address - Phone:985-532-2545
Practice Address - Fax:985-532-5567
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.009532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPST.009532OtherSTATE LICENSE