Provider Demographics
NPI:1487640298
Name:REITZELL, SAMMY H JR
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:H
Last Name:REITZELL
Suffix:JR
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 1:615 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:LA
Mailing Address - Zip Code:71417-1414
Mailing Address - Country:US
Mailing Address - Phone:318-627-5428
Mailing Address - Fax:318-627-4187
Practice Address - Street 1:615 8TH ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:LA
Practice Address - Zip Code:71417-1414
Practice Address - Country:US
Practice Address - Phone:318-627-5428
Practice Address - Fax:318-627-4187
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA9968OtherLA BOARD OF PHAMACY