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NPI Code Detail

MEDICARE: STEPHEN L LAFRANCE PHARMACY INC

MEDICARE: STEPHEN L LAFRANCE PHARMACY INC
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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacy

General Provider Information

NPI Number : 1558617571
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEPHEN L LAFRANCE PHARMACY INC
Provider Business Mailing Address
First Line : 1901 E VOORHEES ST
Second Line : MS 790
City : DANVILLE
State : IL
Zip : 61834-4509
Country : US
Telephone Number : 217-709-2386
Fax Number : 217-709-2344
Provider Business Practice Location Address
First Line : 1920 MALCOLM AVENUE
Second Line :
City : NEWPORT
State : AR
Zip : 72112-3628
Country : US
Telephone Number : 870-523-9889
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. KERMIT R CRAWFORD
Credential :
Telephone Number : 847-315-3154
Provider Enumeration Date : 07/27/2012
Last Update Date : 10/01/2012

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