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General NPI Number Information
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NPI Number | 1609936012
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Entity Type | Organization
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Legal Business Name | MONROE MEDICAL CLINIC PHARMACY
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 100 S 2ND ST
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City | MONROE
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State | LA
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Zip | 71201-8537
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Country | US
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Telephone | 318-322-0319
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Fax |
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Provider Business Mailing Address
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Address Line | 100 S 2ND ST
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City | MONROE
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State | LA
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Zip | 71201-8537
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Country | US
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Telephone | 318-322-0319
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Fax |
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | CANDY JONES
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Credential |
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Telephone | 318-322-0319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 4928 IR
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15546
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License Number State | LA
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