| NPI | 1124202486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN BIENVENU Doctor 225-767-1311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: LA 022546) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2007-12-21 |