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NPI Code Detail

MEDICARE: DENICE GORDY PHARMACIST

MEDICARE: DENICE GORDY PHARMACIST
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
1183500000XPharmacist016016LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11346267614OTHERNPI

General Provider Information

NPI Number : 1346726692
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENICE GORDY PHARMACIST
Provider Business Mailing Address
First Line : 1647 HIGHWAY 124 E
Second Line :
City : KELLY
State : LA
Zip : 71441-2028
Country : US
Telephone Number : 318-495-3558
Fax Number :
Provider Business Practice Location Address
First Line : 3670 W OAK ST
Second Line :
City : JENA
State : LA
Zip : 71342-4474
Country : US
Telephone Number : 318-992-1357
Fax Number : 318-992-1359
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2018
Last Update Date : 07/18/2018

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