Healthcare Provider Details

I. General information

NPI: 1548310881
Provider Name (Legal Business Name): GEORGE ELLIOTT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 HWY 74
ST GABRIEL LA
70776
US

IV. Provider business mailing address

PO BOX 74
SAINT GABRIEL LA
70776-0074
US

V. Phone/Fax

Practice location:
  • Phone: 225-642-9000
  • Fax: 225-642-9002
Mailing address:
  • Phone: 225-642-9000
  • Fax: 225-642-9022

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 NumberPHY004743IR
License Number StateLA

VIII. Authorized Official

Name: CLIFTON ELLIOTT
Title or Position: OWNER
Credential: PHRM
Phone: 225-642-9000