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General NPI Number Information
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NPI Number | 1356332522
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Entity Type | Organization
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Legal Business Name | ACKAL'S IBERIA PHARMACY INC
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1620 S HOPKINS ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-5826
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Country | US
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Telephone | 337-364-7271
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Fax | 337-369-9344
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Provider Business Mailing Address
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Address Line | PO BOX 12311
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City | NEW IBERIA
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State | LA
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Zip | 70562-2311
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Country | US
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Telephone | 337-364-7271
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Fax | 337-369-9344
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Authorized Official
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Title or Position | PHARMACY MANAGER/VICE PRESIDENT
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Name | MR. JAMES J MOURET
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Credential | RPH
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Telephone | 337-364-7271
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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 | C00008IR
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License Number State | LA
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