Provider Demographics
NPI:1528289493
Name:TOSSPON, GWEN D (RPH)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:D
Last Name:TOSSPON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 JANET DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-7700
Mailing Address - Country:US
Mailing Address - Phone:318-473-8826
Mailing Address - Fax:318-443-3635
Practice Address - Street 1:3592 HIGHWAY 28 E
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5816
Practice Address - Country:US
Practice Address - Phone:318-443-3100
Practice Address - Fax:318-443-3635
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist