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General NPI Number Information
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NPI Number | 1689030686
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHARMACY RX, LLC
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 1414 JACKSON ST
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City | ALEXANDRIA
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State | LA
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Zip | 71301-6931
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Country | US
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Telephone | 318-442-4485
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Fax | 318-443-6410
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Provider Business Mailing Address
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Address Line | 1414 JACKSON ST
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City | ALEXANDRIA
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State | LA
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Zip | 71301-6931
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Country | US
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Telephone | 318-442-4485
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Fax | 318-443-6410
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. DARLA W CORLEY
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Credential | RPH
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Telephone | 318-442-4485
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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.007236-IR
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License Number State | LA
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