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General NPI Number Information
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NPI Number | 1366439648
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Entity Type | Organization
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Legal Business Name | MOUTON PHARMACY INC
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 301 S ADAMS AVE
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City | RAYNE
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State | LA
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Zip | 70578-5837
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Country | US
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Telephone | 337-334-2117
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Fax | 337-334-7668
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Provider Business Mailing Address
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Address Line | PO BOX 93
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City | RAYNE
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State | LA
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Zip | 70578-0093
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | ANDREW MOUTON
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Credential |
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Telephone | 337-334-2117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PHY.002569-IR
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License Number State | LA
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Taxonomy #2
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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 #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | OS01568
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License Number State | AR
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