Organization
MEDIC PHARMACY OF BASTROP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM GARY GRAYSON SR. RPH (OWNER/PRESIDENT/PHARMACIST)
(318) 281-3291
Entity
Organization
Contact information
Practice address
1821 N WASHINGTON ST, BASTROP, LA 71220-2441
(318) 281-3291
(318) 281-3292
Mailing address
1821 N WASHINGTON ST, BASTROP, LA 71220-2441
(318) 281-3291
(318) 281-3292
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
0304220001
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1533611
—
LA
01
—
1903649
NAPB
LA
01
—
C5068
BLUE CROSS BLUE SHIELD OF
LA
Enumeration date
01/11/2006
Last updated
08/22/2020
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