Provider Demographics
NPI:1447704457
Name:SENG, IAN ELLIOTT (PHARM D)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:ELLIOTT
Last Name:SENG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 RIVER PARKWAY BLVD
Mailing Address - Street 2:APT 402
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-1808
Mailing Address - Country:US
Mailing Address - Phone:501-786-0736
Mailing Address - Fax:
Practice Address - Street 1:400 W MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-9449
Practice Address - Country:US
Practice Address - Phone:318-949-3702
Practice Address - Fax:318-949-3702
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist