Provider Demographics
NPI:1437432879
Name:QAISI, LAITH KAMEL
Entity Type:Individual
Prefix:DR
First Name:LAITH
Middle Name:KAMEL
Last Name:QAISI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2116
Mailing Address - Country:US
Mailing Address - Phone:318-869-3453
Mailing Address - Fax:318-869-0784
Practice Address - Street 1:3300 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2116
Practice Address - Country:US
Practice Address - Phone:318-869-3453
Practice Address - Fax:318-869-0784
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist