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General NPI Number Information
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NPI Number | 1588725303
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Entity Type | Organization
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Legal Business Name | PHARMACIE LLC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 209 S AIRLINE HWY
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City | GONZALES
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State | LA
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Zip | 70737-3635
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Country | US
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Telephone | 225-644-7424
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Fax | 225-644-7434
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Provider Business Mailing Address
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Address Line | 209 S AIRLINE HWY
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City | GONZALES
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State | LA
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Zip | 70737-3635
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Country | US
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Telephone | 225-644-7424
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Fax | 225-644-7434
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | NORRIS TUREAU
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Credential | RPH
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Telephone | 225-644-7288
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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 | PHY.005728-IR
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License Number State | LA
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