Organization
WALTER BIRDSALL PHARMACY INC
Active
Other names
WALTER BIRDSALL PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER BIRDSALL RPH (PRESIDENT / PIC)
(985) 632-5003
Entity
Organization
Contact information
Practice address
118 W 111TH ST, CUT OFF, LA 70345-3620
(985) 632-5003
(985) 632-5083
Mailing address
PO BOX 840, CUT OFF, LA 70345-0840
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY001188IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1204421
—
LA
01
—
2028711
PK
—
Enumeration date
10/03/2006
Last updated
04/04/2016
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