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General NPI Number Information
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NPI Number | 1316068281
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Entity Type | Organization
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Legal Business Name | PRIDE PLAZA PHARMACY INC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 850 N PIERCE ST
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City | LAFAYETTE
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State | LA
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Zip | 70501-2848
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Country | US
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Telephone | 333-237-4571
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Fax | 337-237-1956
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Provider Business Mailing Address
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Address Line | 850 N PIERCE ST
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City | LAFAYETTE
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State | LA
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Zip | 70501-2848
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Country | US
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Telephone | 333-237-4571
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Fax | 337-237-1956
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | MS. MARTHA H HEGWOOD
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Credential | RPH
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Telephone | 337-237-4571
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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 | 2446 IR
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License Number State | LA
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