Healthcare Provider Details

I. General information

NPI: 1134219066
Provider Name (Legal Business Name): GEORGE M. VIGUERIE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MIKE VIGUERIE RPH

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 HOSPITAL AVE
FRANKLIN LA
70538-3722
US

IV. Provider business mailing address

1500 LAKE SIDE DR
NEW IBERIA LA
70560-1419
US

V. Phone/Fax

Practice location:
  • Phone: 337-828-0950
  • Fax:
Mailing address:
  • Phone: 337-367-6608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16054
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: