# NORTHSIDE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NORTHSIDE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184778532
- **Authorized official:** NOLAN COURVILLE (MANAGING PARTNER)
- **Authorized official phone:** (337) 232-2666

## Contact information

- **Practice address:** 2930 MOSS ST, STE A, LAFAYETTE, LA 70501-1274
- **Practice address phone:** (337) 232-2666
- **Practice address fax:** (337) 233-5978
- **Mailing address:** 2930 MOSS ST, STE A, LAFAYETTE, LA 70501-1274
- **Mailing address phone:** (337) 232-2666
- **Mailing address fax:** (337) 233-5978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY004593IR | LA | Yes |

## Other

- **Enumeration date:** 01/23/2007
- **Last updated:** 03/15/2017