Healthcare Provider Details

I. General information

NPI: 1225020753
Provider Name (Legal Business Name): HENRY HUBERT CAZENTRE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E. MAIN STREET
GRAMERCY LA
70052-1511
US

IV. Provider business mailing address

PO BOX 397
GRAMERCY LA
70052-0397
US

V. Phone/Fax

Practice location:
  • Phone: 225-869-3651
  • Fax: 225-869-8826
Mailing address:
  • Phone: 225-869-8726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9579
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: