MEDICARE: ST AMANT 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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY001525IR	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2030914	OTHER		PK

General Provider Information

NPI Number	:	1710092119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST AMANT PHARMACY INC

Provider Business Mailing Address
First Line	:	12502 HIGHWAY 431
Second Line	:
City	:	SAINT AMANT
State	:	LA
Zip	:	70774-3418
Country	:	US
Telephone Number	:	225-644-7288
Fax Number	:	225-647-6639

Provider Business Practice Location Address
First Line	:	12502 HIGHWAY 431
Second Line	:
City	:	SAINT AMANT
State	:	LA
Zip	:	70774-3418
Country	:	US
Telephone Number	:	225-644-7288
Fax Number	:	225-647-6639

Authorized Official
Title or Position	:	OWNER
Name	:	NORRIS TUREAU
Credential	:	RPH
Telephone Number	:	225-622-1959

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	02/18/2015

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Directions to “ST AMANT PHARMACY INC ” Practice Location

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