Healthcare Provider Details

I. General information

NPI: 1740548601
Provider Name (Legal Business Name): SWLA CENTER FOR HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PATTERSON ST
LAFAYETTE LA
70501-1849
US

IV. Provider business mailing address

500 PATTERSON ST
LAFAYETTE LA
70501-1849
US

V. Phone/Fax

Practice location:
  • Phone: 337-769-6533
  • Fax: 337-769-9468
Mailing address:
  • Phone: 337-769-6533
  • Fax: 337-769-9468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY006508IR
License Number StateLA

VIII. Authorized Official

Name: CORNELL JOUBERT
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 337-769-6533