MEDICARE: GARRETT MIRE

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	014281	LA

General Provider Information

NPI Number	:	1376098897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT MIRE

Provider Business Mailing Address
First Line	:	4049 WHITEVILLE RD
Second Line	:
City	:	VILLE PLATTE
State	:	LA
Zip	:	70586-7419
Country	:	US
Telephone Number	:	337-942-4228
Fax Number	:	337-942-8935

Provider Business Practice Location Address
First Line	:	4049 WHITEVILLE RD
Second Line	:
City	:	VILLE PLATTE
State	:	LA
Zip	:	70586-7419
Country	:	US
Telephone Number	:	337-942-4228
Fax Number	:	337-942-8935

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

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	08/25/2016

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Directions to “ GARRETT MIRE ” Practice Location

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