Healthcare Provider Details

I. General information

NPI: 1356990436
Provider Name (Legal Business Name): PENNY POUNCEY HUTCHESON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PENNY POUNCEY ADAMS RPH

II. Dates (important events)

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

III. Provider practice location address

1201 N SERVICE RD E
RUSTON LA
71270-2917
US

IV. Provider business mailing address

100 RUE TOULOUSE
WEST MONROE LA
71291-2096
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-0392
  • Fax:
Mailing address:
  • Phone: 318-393-7265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD12463
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.013351
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: