Healthcare Provider Details

I. General information

NPI: 1346352291
Provider Name (Legal Business Name): GEORGE ELLIOTT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 HOSPITAL RD
NEW ROADS LA
70760-2619
US

IV. Provider business mailing address

222 HOSPITAL RD
NEW ROADS LA
70760-2619
US

V. Phone/Fax

Practice location:
  • Phone: 225-638-6321
  • Fax: 225-638-6322
Mailing address:
  • Phone: 225-638-6321
  • Fax: 225-638-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY006279IR
License Number StateLA

VIII. Authorized Official

Name: ERIC ELLIOTT
Title or Position: OWNER
Credential:
Phone: 225-625-2353