Healthcare Provider Details

I. General information

NPI: 1215034053
Provider Name (Legal Business Name): MANSFIELD DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 JEFFERSON ST
MANSFIELD LA
71052-2602
US

IV. Provider business mailing address

PO BOX 1329
MANSFIELD LA
71052-1329
US

V. Phone/Fax

Practice location:
  • Phone: 318-872-1933
  • Fax: 318-872-5816
Mailing address:
  • Phone: 318-872-1933
  • Fax: 318-872-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.006935-IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HELEN DUCOTE
Title or Position: SECRETARY/OWNER
Credential:
Phone: 318-872-1933