Organization
VIDRINE PHARMACEUTICAL GROUP, LLC
Active
Parent organization
VIDRINE PHARMACEUTICAL GROUP, LLC
Other names
Boudreaux's New Drug Store
Organization subpart
Yes
Provider details
NPI number
Legal business name
VIDRINE PHARMACEUTICAL GROUP, LLC
Authorized official
MR. JESSE VIDRINE (OWNER)
(337) 436-7216
Entity
Organization
Contact information
Practice address
404 E PRIEN LAKE RD, LAKE CHARLES, LA 70601-8507
(337) 436-7216
Mailing address
404 E PRIEN LAKE RD, LAKE CHARLES, LA 70601-8507
(337) 436-7216
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
07/13/2020
Last updated
07/17/2020
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