Healthcare Provider Details

I. General information

NPI: 1811086002
Provider Name (Legal Business Name): ROUSES ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 CRESCENT AVE
LOCKPORT LA
70374-3106
US

IV. Provider business mailing address

PO BOX 5358
THIBODAUX LA
70302-5358
US

V. Phone/Fax

Practice location:
  • Phone: 985-532-2545
  • Fax: 985-532-5567
Mailing address:
  • Phone: 985-447-5998
  • Fax: 985-447-5563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY003457IR
License Number StateLA

VIII. Authorized Official

Name: ALLISON ROYSTER
Title or Position: OWNER/MNGNG MBR
Credential: R.PH.
Phone: 985-447-5998