Healthcare Provider Details

I. General information

NPI: 1578625182
Provider Name (Legal Business Name): HOUMA URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CORPORATE DR
HOUMA LA
70360-2767
US

IV. Provider business mailing address

131 CORPORATE DR
HOUMA LA
70360-2767
US

V. Phone/Fax

Practice location:
  • Phone: 985-580-9996
  • Fax: 985-580-9987
Mailing address:
  • Phone: 985-580-9996
  • Fax: 985-580-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.005311-IR
License Number StateLA

VIII. Authorized Official

Name: MARIAN PITRE
Title or Position: PIC
Credential:
Phone: 985-580-9996