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General NPI Number Information
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NPI Number | 1841668530
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Entity Type | Organization
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Legal Business Name | OLD GRETNA PHARMACY, LLC
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 500 LAFAYETTE ST
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City | GRETNA
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State | LA
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Zip | 70053-5936
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Country | US
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Telephone | 504-252-9686
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Fax | 504-252-9839
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Provider Business Mailing Address
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Address Line | PO BOX 661
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City | GRETNA
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State | LA
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Zip | 70054-0661
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Country | US
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Telephone | 504-252-9686
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Fax | 504-252-9839
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Authorized Official
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Title or Position | MANAGER
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Name | AMY STEELE
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Credential |
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Telephone | 504-252-9686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | PHY006869IR
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License Number State | LA
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