Provider Demographics
NPI:1255611307
Name:DUCOTE, EDMOND GABRIEL (RPH)
Entity type:Individual
Prefix:MR
First Name:EDMOND
Middle Name:GABRIEL
Last Name:DUCOTE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 NORRIS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7719
Mailing Address - Country:US
Mailing Address - Phone:318-797-9302
Mailing Address - Fax:318-797-9302
Practice Address - Street 1:3124 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-4240
Practice Address - Country:US
Practice Address - Phone:318-222-4807
Practice Address - Fax:318-872-5816
Is Sole Proprietor?:No
Enumeration Date:2011-08-21
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist