Healthcare Provider Details

I. General information

NPI: 1275645129
Provider Name (Legal Business Name): MEDICAL CENTER PHARMACY OF MANY LA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 S CAPITOL ST
MANY LA
71449-3049
US

IV. Provider business mailing address

PO BOX 479
MANY LA
71449-0479
US

V. Phone/Fax

Practice location:
  • Phone: 318-256-5658
  • Fax: 318-256-9599
Mailing address:
  • Phone: 318-256-5658
  • Fax: 318-256-9599

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 NumberPHY.005210-IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SCOTT GEWIN
Title or Position: OWNER PRESIDENT
Credential: PHARMD
Phone: 318-256-5658