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General NPI Number Information
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NPI Number | 1144349036
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Entity Type | Organization
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Legal Business Name | ROUSE'S PHARMACY #15
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1410 SAINT CHARLES ST
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City | HOUMA
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State | LA
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Zip | 70360-3935
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Country | US
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Telephone | 985-580-2525
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Fax | 985-580-0469
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Provider Business Mailing Address
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Address Line | 1410 SAINT CHARLES ST
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City | HOUMA
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State | LA
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Zip | 70360-3935
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Country | US
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Telephone | 985-580-2525
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Fax | 985-580-0469
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. MARK MALOUSE
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Credential | R.PH.
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Telephone | 985-580-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4596IR
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License Number State | LA
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