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General NPI Number Information
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NPI Number | 1437362209
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Entity Type | Organization
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Legal Business Name | CLINTON DRUGSTORE
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 10/06/2009
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Provider Practice Location Address
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Address Line | 1027 ST HELENA
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City | CLINTON
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State | LA
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Zip | 70722-1027
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Country | US
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Telephone | 225-683-9805
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 209
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City | CLINTON
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State | LA
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Zip | 70722
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Country | US
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Telephone | 225-683-9805
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. LARRY ROSS COCKRELL
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Credential | P.D.
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Telephone | 225-683-9805
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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 | 185 IR
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License Number State | LA
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