Provider Demographics
NPI:1255118675
Name:LABORDE, KEELEY RICHARD
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:RICHARD
Last Name:LABORDE
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 1:1829 MAIN HWY # 31
Mailing Address - Street 2:
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512-4116
Mailing Address - Country:US
Mailing Address - Phone:337-412-1092
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:800-375-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist