Provider Demographics
NPI:1871190413
Name:ANDERS, CALEB DANIEL (PST023506)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:DANIEL
Last Name:ANDERS
Suffix:
Gender:M
Credentials:PST023506
Other - Prefix:DR
Other - First Name:CALEB
Other - Middle Name:DANIEL
Other - Last Name:ANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1333 COATES BLUFF DR APT 721
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2820
Mailing Address - Country:US
Mailing Address - Phone:318-557-7029
Mailing Address - Fax:
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:800-863-7441
Practice Address - Fax:318-990-5750
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist