| NPI | 1174635023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE GARDINER Pres 318-352-4582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: LA PHY005982) |
| Additional Taxonomies | 3336L0003X Pharmacy Long Term Care Pharmacy |
| 3336H0001X Pharmacy Home Infusion Therapy Pharmacy | |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-02-10 |