Healthcare Provider Details

I. General information

NPI: 1639271059
Provider Name (Legal Business Name): MEDICINE SHOPPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 JACKSON
ALEXANDRIA LA
71303-2000
US

IV. Provider business mailing address

4730 JACKSON
ALEXANDRIA LA
71303-2000
US

V. Phone/Fax

Practice location:
  • Phone: 318-448-2445
  • Fax: 318-448-9626
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3816IR
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN GUINN
Title or Position: BILLING SPEC
Credential:
Phone: 314-993-6000