Healthcare Provider Details

I. General information

NPI: 1811340193
Provider Name (Legal Business Name): SCOTTS APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SERIO BLVD
FERRIDAY LA
71334-2013
US

IV. Provider business mailing address

PO BOX 669
FERRIDAY LA
71334-0669
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-3035
  • Fax: 318-757-3271
Mailing address:
  • Phone: 318-757-3035
  • Fax: 318-757-3271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.007353-IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SCOTT EMFINGER
Title or Position: PIC/OWNER
Credential:
Phone: 318-757-3035