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Organization
NORTHSIDE PHARMACY LLC
Active
Organization
NORTHSIDE PHARMACY LLC
Active
Other names
NORTHSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
NOLAN COURVILLE (MANAGING PARTNER)
(337) 232-2666
Entity
Organization
Contact information
Practice address
2930 MOSS ST, STE A, LAFAYETTE, LA 70501-1274
(337) 232-2666
(337) 233-5978
Mailing address
2930 MOSS ST, STE A, LAFAYETTE, LA 70501-1274
(337) 232-2666
(337) 233-5978
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHY004593IR
LA
Other
Enumeration date
01/23/2007
Last updated
03/15/2017
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