Healthcare Provider Details

I. General information

NPI: 1659453447
Provider Name (Legal Business Name): LANDRYS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BURNSIDE AVE
GONZALES LA
70737-2828
US

IV. Provider business mailing address

416 N BURNSIDE AVE
GONZALES LA
70737-2828
US

V. Phone/Fax

Practice location:
  • Phone: 225-647-3583
  • Fax: 225-644-3363
Mailing address:
  • Phone: 225-647-3583
  • Fax: 225-644-3363

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.000645-IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES LANDRY
Title or Position: OWNER PHCST
Credential: RPH
Phone: 225-647-3583