Provider Demographics
NPI:1730673658
Name:LAFFITTE, STEPHANIE DEANN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DEANN
Last Name:LAFFITTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-3202
Mailing Address - Country:US
Mailing Address - Phone:318-259-7333
Mailing Address - Fax:
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-3202
Practice Address - Country:US
Practice Address - Phone:318-259-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist