| NPI | 1518003722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRBY BONVILLAIN Pharmacist 985-853-2885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: LA 6100-IR) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: LA 6100-IR) |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: LA 6100-IR) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2009-06-02 |