Organization
MEDCORE SPECIALTY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAY MABILE RPH (OWNER/PHARMACIST)
(318) 932-3083
Entity
Organization
Contact information
Practice address
1435 E. CARROLL ST., SUITE B, COUSHATTA, LA 71019
(318) 932-8661
Mailing address
1435 E. CARROLL ST., SUITE B, COUSHATTA, LA 71019
(318) 932-8661
Taxonomy
Speciality
Code
Description
License number
State
3336S0011X
Specialty Pharmacy
Primary
6118
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6118
LA BOARD OF PHARMACY PERMIT
LA
Enumeration date
05/27/2009
Last updated
05/27/2009
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