Healthcare Provider Details

I. General information

NPI: 1609936012
Provider Name (Legal Business Name): MONROE MEDICAL CLINIC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 2ND ST
MONROE LA
71201-8537
US

IV. Provider business mailing address

100 S 2ND ST
MONROE LA
71201-8537
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-0319
  • Fax:
Mailing address:
  • Phone: 318-322-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15546
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number4928 IR
License Number StateLA

VIII. Authorized Official

Name: CANDY JONES
Title or Position: PHARMACIST OWNER
Credential:
Phone: 318-322-0319