Healthcare Provider Details

I. General information

NPI: 1821081050
Provider Name (Legal Business Name): TOWNE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 06/13/2017
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number006633
License Number StateLA

VIII. Authorized Official

Name: MR. IVAN JOE LANDRY
Title or Position: OWNER/PHARMACIST
Credential: PHARM.D.
Phone: 337-839-8880