Healthcare Provider Details

I. General information

NPI: 1548816986
Provider Name (Legal Business Name): JOHN STEVEN VIGUERIE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E MAIN ST
BROUSSARD LA
70518-4616
US

IV. Provider business mailing address

103 E MAIN ST
BROUSSARD LA
70518-4616
US

V. Phone/Fax

Practice location:
  • Phone: 337-839-8880
  • Fax: 337-839-8881
Mailing address:
  • Phone: 337-839-8880
  • Fax: 337-839-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number011914
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: