Healthcare Provider Details

I. General information

NPI: 1497190227
Provider Name (Legal Business Name): MEDICAL PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4965 W. PARK DRIVE
ZACHARY LA
70791
US

IV. Provider business mailing address

PO BOX 475
ZACHARY LA
70791-0475
US

V. Phone/Fax

Practice location:
  • Phone: 225-654-6884
  • Fax:
Mailing address:
  • Phone: 225-654-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number2235IR
License Number StateLA

VIII. Authorized Official

Name: MRS. AUDREY LETARD
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 225-654-6884