MEDICARE: MR. GEORGE M. VIGUERIE RPH

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
1	183500000X	Pharmacist	16054	LA

General Provider Information

NPI Number	:	1134219066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE M. VIGUERIE RPH

Provider Business Mailing Address
First Line	:	1500 LAKE SIDE DR
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-1419
Country	:	US
Telephone Number	:	337-367-6608
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 HOSPITAL AVE
Second Line	:
City	:	FRANKLIN
State	:	LA
Zip	:	70538-3722
Country	:	US
Telephone Number	:	337-828-0950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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