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General NPI Number Information
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NPI Number | 1801953286
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Entity Type | Organization
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Legal Business Name | LIVE OAK PHARMACY INC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 34730 LA HWY 16
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City | WATSON
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State | LA
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Zip | 70786
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Country | US
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Telephone | 225-664-7125
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Fax | 225-664-7869
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Provider Business Mailing Address
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Address Line | PO BOX 829
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City | WATSON
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State | LA
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Zip | 70786-0829
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LUCILLE BABB
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Credential | RPH
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Telephone | 225-664-7125
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY002119IR
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License Number State | LA
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