Healthcare Provider Details

I. General information

NPI: 1487990818
Provider Name (Legal Business Name): ICARE PHAMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 KALISTE SALOOM RD
LAFAYETTE LA
70508-7141
US

IV. Provider business mailing address

2807 KALISTE SALOOM RD
LAFAYETTE LA
70508-7141
US

V. Phone/Fax

Practice location:
  • Phone: 337-889-3170
  • Fax: 337-889-3172
Mailing address:
  • Phone: 337-889-3170
  • Fax: 337-889-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRY JAMES VEILLON JR.
Title or Position: OWNER/PIC
Credential: PHARMD
Phone: 337-889-3170