Healthcare Provider Details

I. General information

NPI: 1780152157
Provider Name (Legal Business Name): VERNON PARISH COMMUNITY HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 NOLAN TRACE PKWAY
LEESVILLE LA
71446-3912
US

IV. Provider business mailing address

806 JEFFERSON TER
NEW IBERIA LA
70560-5727
US

V. Phone/Fax

Practice location:
  • Phone: 337-392-0110
  • Fax:
Mailing address:
  • Phone: 337-365-4945
  • Fax: 337-376-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE DUMOND
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 337-365-4945