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Organization
MAPLE AVENUE PHARMACY INC
Active
Organization
MAPLE AVENUE PHARMACY INC
Active
Other names
Maple Avenue Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AUGUST COURVILLE (OWNER/PIC)
(337) 580-1485
Entity
Organization
Contact information
Practice address
1200 W MAPLE AVE, EUNICE, LA 70535-4320
(337) 457-5216
(337) 457-0920
Mailing address
PO BOX 1002, EUNICE, LA 70535-1002
(337) 457-5216
(337) 457-0920
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHY006500
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135863
PK
—
05
—
2201506
—
LA
Enumeration date
10/07/2006
Last updated
09/28/2016
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