# WILLOW MINA

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

## Provider details

- **NPI number:** 1235689977
- **Authorized official:** MINH NGUYEN (PRESIDENT)
- **Authorized official phone:** (985) 772-4088

## Contact information

- **Practice address:** 606 HIGHWAY 20, THIBODAUX, LA 70301-6255
- **Practice address phone:** (985) 633-2275
- **Practice address fax:** (985) 633-4703
- **Mailing address:** 606 HIGHWAY 20, THIBODAUX, LA 70301-6255
- **Mailing address phone:** (985) 633-2275
- **Mailing address fax:** (985) 633-4703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY.007400-IR | LA | Yes |

## Other

- **Enumeration date:** 10/05/2016
- **Last updated:** 10/17/2024