Healthcare Provider Details

I. General information

NPI: 1770543464
Provider Name (Legal Business Name): WEST CARROLL MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 ROSS ST
OAK GROVE LA
71263-9798
US

IV. Provider business mailing address

706 ROSS ST
OAK GROVE LA
71263-9798
US

V. Phone/Fax

Practice location:
  • Phone: 318-428-6155
  • Fax: 318-428-6172
Mailing address:
  • Phone: 318-428-6155
  • Fax: 318-428-6172

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 Number5244-IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KELLI SCIARA
Title or Position: AUTH REP PHARM DIRECTOR
Credential: RPH
Phone: 318-428-6252