Organization
MAIN STREET PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES WITSCHEN BRYCE II RPH (MANAGER)
(225) 451-5804
Entity
Organization
Contact information
Practice address
5500 FIRE STATION RD STE A, ZACHARY, LA 70791-7468
(225) 451-5804
Mailing address
5500 FIRE STATION RD STE A, ZACHARY, LA 70791-7468
(225) 451-5804
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
—
—
Other
Enumeration date
10/27/2023
Last updated
10/27/2023
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