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General NPI Number Information
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NPI Number | 1114041134
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Entity Type | Organization
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Legal Business Name | PEARSON DRUGS NO. 4, LLC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 N 5TH ST
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City | LEESVILLE
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State | LA
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Zip | 71446-3544
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Country | US
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Telephone | 337-239-4521
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Fax | 337-238-4957
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Provider Business Mailing Address
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Address Line | PO BOX 3640
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City | PINEVILLE
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State | LA
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Zip | 71361-3640
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Country | US
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Telephone | 318-619-1129
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Fax | 318-473-2879
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Authorized Official
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Title or Position | MANAGER
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Name | WALTER BRENT PEARSON
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Credential |
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Telephone | 318-445-1488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 870RC
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License Number State | LA
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