| NPI | 1164565933 |
|---|---|
| Former Legal Business Name | BLAKES SOUTHSIDE PHARMACY INC |
| Entity Type | Organization |
| Authorized Contact | WILLIAM L FORET PIC ( Pharmacist In Charge) 337-363-7497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 10232) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-09-03 |