Provider Demographics
NPI:1740439751
Name:CHRETIEN, LARRY LEON (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LEON
Last Name:CHRETIEN
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 1:510 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4444
Mailing Address - Country:US
Mailing Address - Phone:318-424-0896
Mailing Address - Fax:318-424-0897
Practice Address - Street 1:510 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-4444
Practice Address - Country:US
Practice Address - Phone:318-424-0896
Practice Address - Fax:318-424-0897
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist