Healthcare Provider Details

I. General information

NPI: 1801836473
Provider Name (Legal Business Name): MILLERS FAMILY PHARMACY & GIFT BOUTIQUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S 5TH ST SUITE B
IOTA LA
70543-6105
US

IV. Provider business mailing address

PO BOX 429
IOTA LA
70543-0429
US

V. Phone/Fax

Practice location:
  • Phone: 337-779-2214
  • Fax: 337-779-2215
Mailing address:
  • Phone: 337-779-2214
  • Fax: 337-779-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY003535IR
License Number StateLA

VIII. Authorized Official

Name: GREGORY MILLER
Title or Position: PRESIDENT
Credential: PD
Phone: 337-779-2214