Healthcare Provider Details

I. General information

NPI: 1992791404
Provider Name (Legal Business Name): YANCEYS DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CHRISTIAN DR
RAYVILLE LA
71269-3658
US

IV. Provider business mailing address

PO BOX 120
RAYVILLE LA
71269-0120
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-4195
  • Fax: 318-728-3215
Mailing address:
  • Phone: 318-728-4195
  • Fax: 318-728-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. MARY SPICER
Title or Position: OWNER PHARMACIST
Credential: PHARMD
Phone: 318-728-4195