Organization
OUR LADY OF GUADALUPE PHARMACY
Active
Other names
OUR LADY OF GUADALUPE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LEE OWNER (OWNER)
(337) 826-9810
Entity
Organization
Contact information
Practice address
904 HIGHWAY 363, WASHINGTON, LA 70589-4141
(337) 826-9810
(337) 826-9813
Mailing address
904 HIGHWAY 363, WASHINGTON, LA 70589-4141
(337) 826-9810
(337) 826-9813
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY005564IR
LA
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1210790
—
LA
01
—
2035290
PK
—
Enumeration date
10/23/2006
Last updated
03/15/2017
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