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General NPI Number Information
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NPI Number | 1588799779
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Entity Type | Organization
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Legal Business Name | CLINIC DRUG STORE OF GOLDEN MEADOW INC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 110 SOUTH BAYOU DRIVE
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City | GOLDEN MEADOW
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State | LA
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Zip | 70357
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Country | US
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Telephone | 985-475-7777
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Fax | 985-475-7888
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Provider Business Mailing Address
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Address Line | 110 S BAYOU DR
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City | GOLDEN MEADOW
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State | LA
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Zip | 70357-2728
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Country | US
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Telephone | 985-475-7777
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Fax | 985-475-7888
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. TIMOTHY JOHN CALLAIS
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Credential | PHARM.D.
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Telephone | 985-475-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16430
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License Number State | LA
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