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1609161256
JEREMY RANDALL MOFFETT
SHREVEPORT, LA
NPI
1609161256
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
183500000X Pharmacist
(Licence: LA 16563)
Enumeration Date
2011-06-11
Last Update Date
2011-06-11
Business Address
-- JEREMY RANDALL MOFFETT
7110 YOUREE DR
SHREVEPORT, LA 71105-5107
Phone number: 318-798-7860
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Mailing Address
-- JEREMY RANDALL MOFFETT
151 WATERS EDGE DR
SHREVEPORT, LA 71106-7775
Phone number: 318-798-6593
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