Provider Demographics
NPI:1326174202
Name:LOFTIN, DAVID W (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:LOFTIN
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 1:4988 SWAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6404
Mailing Address - Country:US
Mailing Address - Phone:318-746-0578
Mailing Address - Fax:
Practice Address - Street 1:5604 BENTON RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006
Practice Address - Country:US
Practice Address - Phone:318-746-0151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist