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General NPI Number Information
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NPI Number | 1487737565
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Entity Type | Organization
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Legal Business Name | PEARSON SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 2804 N BOLTON AVE
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City | ALEXANDRIA
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State | LA
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Zip | 71303-4509
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Country | US
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Telephone | 318-448-7366
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Fax | 318-448-1328
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Provider Business Mailing Address
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Address Line | PO BOX 7796
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City | ALEXANDRIA
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State | LA
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Zip | 71306-0796
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Country | US
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Telephone | 318-448-7366
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Fax | 318-448-1328
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Authorized Official
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Title or Position | CO OWNER
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Name | MARTY MCKAY
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Credential | RPH
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Telephone | 318-776-5646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY005638IR
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License Number State | LA
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