# BLAKES SOUTHSIDE PHARMACY PHASE II LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blakes Southside Pharmacy INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164565933
- **Authorized official:** MR. WILLIAM L FORET PHARMACIST (PIC ( PHARMACIST IN CHARGE))
- **Authorized official phone:** (337) 363-7497

## Contact information

- **Practice address:** 808 S. CHATAIGNIER RD, VILLE PLATTE, LA 70586
- **Practice address phone:** (337) 363-7497
- **Practice address fax:** (337) 363-0473
- **Mailing address:** 808 S. CHATAIGNIER RD, VILLE PLATTE, LA 70586
- **Mailing address phone:** (337) 363-7497
- **Mailing address fax:** (337) 363-0473

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 10232 | LA | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 02/14/2007
- **Last updated:** 09/03/2020