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NPI Code Detail

MEDICARE: MR. SI CONG VAN PHARMD

MEDICARE: MR. SI CONG VAN PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist18052LA

General Provider Information

NPI Number : 1063727006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SI CONG VAN PHARMD
Provider Business Mailing Address
First Line : 1021 BEGLIS PKWY
Second Line :
City : SULPHUR
State : LA
Zip : 70663-5601
Country : US
Telephone Number : 337-527-6575
Fax Number :
Provider Business Practice Location Address
First Line : 1021 BEGLIS PKWY
Second Line :
City : SULPHUR
State : LA
Zip : 70663-5601
Country : US
Telephone Number : 337-527-6575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2010
Last Update Date : 08/14/2010

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Directions to “ MR. SI CONG VAN PHARMD” Practice Location

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