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General NPI Number Information
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NPI Number | 1679693501
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Entity Type | Organization
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Legal Business Name | MEDICENTER INC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 121 TURKEY LANE
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City | KINDER
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State | LA
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Zip | 70648
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Country | US
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Telephone | 337-738-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 121 TURKEY LANE
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City | KINDER
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State | LA
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Zip | 70648
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Country | US
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Telephone | 337-738-7445
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MICHAEL SONNIER
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Credential | PHD
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Telephone | 337-738-7445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | C00530
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License Number State | LA
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