Healthcare Provider Details

I. General information

NPI: 1174635023
Provider Name (Legal Business Name): GARDINERS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 PARKWAY DR
NATCHITOCHES LA
71457-6276
US

IV. Provider business mailing address

1053 PARKWAY DR
NATCHITOCHES LA
71457-6276
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-4582
  • Fax: 318-357-0778
Mailing address:
  • Phone: 318-352-4582
  • Fax: 318-357-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY005982
License Number StateLA

VIII. Authorized Official

Name: GEORGE GARDINER
Title or Position: PRES
Credential: RPH
Phone: 318-352-4582