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Organization
LIL BOOS CORNER STORE LLC
Active
Organization
LIL BOOS CORNER STORE LLC
Active
Other names
Lil Boos Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MADDOX IV (OWNER)
(318) 793-2028
Entity
Organization
Contact information
Practice address
415 ST. CLAIR RD. STE. C, BOYCE, LA 71409
(318) 793-2028
(859) 594-6639
Mailing address
415 ST. CLAIR ROAD; SUITE C, BOYCE, LA 71409
(318) 793-2028
(859) 594-6639
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007439-IR
LA
Other
Enumeration date
02/24/2017
Last updated
07/18/2023
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