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General NPI Number Information
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NPI Number | 1467767194
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Entity Type | Organization
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Legal Business Name | WILDEL, LLC
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3311 3RD ST
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City | ALEXANDRIA
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State | LA
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Zip | 71302-5704
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Country | US
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Telephone | 318-787-2788
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Fax | 318-787-6284
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Provider Business Mailing Address
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Address Line | 3311 3RD ST
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City | ALEXANDRIA
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State | LA
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Zip | 71302-5704
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Country | US
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Telephone | 318-787-2788
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Fax | 318-787-6284
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BETSY MAYES
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Credential |
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Telephone | 318-448-2445
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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 | 6289IR
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License Number State | LA
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