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General NPI Number Information
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NPI Number | 1033261029
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Entity Type | Organization
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Legal Business Name | GOUX PHARMACY LLC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 599 TUNICA DRIVE WEST
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City | MARKSVILLE
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State | LA
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Zip | 71351
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Country | US
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Telephone | 318-240-9866
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Fax | 318-240-8849
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Provider Business Mailing Address
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Address Line | 599 TUNICA DR W
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City | MARKSVILLE
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State | LA
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Zip | 71351-2628
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Country | US
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Telephone | 318-240-9866
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Fax | 318-240-8849
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Authorized Official
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Title or Position | PHRM OWNER
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Name | KINMAN GOUX
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Credential |
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Telephone | 318-240-9866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 4805
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License Number State | LA
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