Healthcare Provider Details

I. General information

NPI: 1902296478
Provider Name (Legal Business Name): UNION CARE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 CORPORATE DR SUITE A
HOUMA LA
70360-2458
US

IV. Provider business mailing address

304 CORPORATE DR SUITE A
HOUMA LA
70360-2458
US

V. Phone/Fax

Practice location:
  • Phone: 985-262-8214
  • Fax: 985-246-3648
Mailing address:
  • Phone: 985-262-8214
  • Fax: 985-346-3648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHY.007124-IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHY.007124-IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHY.007124-IR
License Number StateLA

VIII. Authorized Official

Name: THANH V. NGUYEN
Title or Position: CEO
Credential:
Phone: 504-606-8747