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General NPI Number Information
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NPI Number | 1386049518
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Entity Type | Organization
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Legal Business Name | HOSPITAL SERVICE DISTRICT NO. 1 OF TANGIPAHOA PARISH
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 15790 PAUL VEGA MD DR RETAIL PHARMACY
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City | HAMMOND
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State | LA
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Zip | 70403-1434
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Country | US
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Telephone | 985-230-3383
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Fax | 985-230-6484
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Provider Business Mailing Address
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Address Line | 15790 PAUL VEGA MD DR
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City | HAMMOND
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State | LA
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Zip | 70403-1434
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Country | US
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Telephone | 985-230-7979
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Fax | 985-230-6484
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Authorized Official
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Title or Position | C.F.O
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Name | MR. MARK ANDERSON
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Credential |
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Telephone | 985-230-6602
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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 | 6979
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License Number State | LA
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