Healthcare Provider Details

I. General information

NPI: 1124016092
Provider Name (Legal Business Name): THE PRESCRIPTION SHOPPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N CUSHING AVE
KAPLAN LA
70548-4122
US

IV. Provider business mailing address

PO BOX 324 308 NORTH CUSHING
KAPLAN LA
70548-0324
US

V. Phone/Fax

Practice location:
  • Phone: 337-643-6493
  • Fax: 337-643-6495
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1100
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GORDON EDWARD HERPIN
Title or Position: OWNER
Credential:
Phone: 337-643-6493