Healthcare Provider Details

I. General information

NPI: 1356307573
Provider Name (Legal Business Name): MILLS CASHWAY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 MARTIN ST
PARKS LA
70582-6255
US

IV. Provider business mailing address

1027 MARTIN ST
PARKS LA
70582-6255
US

V. Phone/Fax

Practice location:
  • Phone: 337-845-5199
  • Fax: 337-845-5070
Mailing address:
  • Phone: 337-845-5199
  • Fax: 337-845-5070

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.001641-IR
License Number StateLA

VIII. Authorized Official

Name: RAMI BRIGNAC
Title or Position: MANAGER
Credential: RPH
Phone: 337-845-5199