MEDICARE: MINSKY-SALEMI INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	4188IR	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1915062	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1568544351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINSKY-SALEMI INC

Provider Business Mailing Address
First Line	:	303 N HOOD ST
Second Line	:
City	:	LAKE PROVIDENCE
State	:	LA
Zip	:	71254-2141
Country	:	US
Telephone Number	:	318-559-2433
Fax Number	:	318-559-2437

Provider Business Practice Location Address
First Line	:	303 N HOOD ST
Second Line	:
City	:	LAKE PROVIDENCE
State	:	LA
Zip	:	71254-2141
Country	:	US
Telephone Number	:	318-559-2433
Fax Number	:	318-559-2437

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	THERESA BROWN
Credential	:	RPH
Telephone Number	:	318-559-2433

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	09/17/2012

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Directions to “MINSKY-SALEMI INC ” Practice Location

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