Organization
LOUVELLA H GRANGER
Active
Other names
THE COMPOUNDING CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DARRELL GRANGER RPH (OWNER PHCST)
(337) 981-8844
Entity
Organization
Contact information
Practice address
3810 AMBASSADOR CAFFERY PKWY STE 200, LAFAYETTE, LA 70503-5259
(337) 981-8844
(337) 981-8884
Mailing address
3810 AMBASSADOR CAFFERY PKWY, STE 200, LAFAYETTE, LA 70503-5259
(337) 981-8844
(337) 981-8884
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.005007-IR
LA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2035103
PK
—
Enumeration date
12/29/2006
Last updated
01/18/2017
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