Organization
STEVENS PHARMACY INC
Active
Other names
STEVENS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN GOUGH (PRESIDENT)
(225) 336-4456
Entity
Organization
Contact information
Practice address
520 S ALEXANDER AVE, STE 200, PORT ALLEN, LA 70767-3100
(225) 336-4456
(225) 336-4458
Mailing address
520 S ALEXANDER AVE, STE 200, PORT ALLEN, LA 70767-3100
(225) 336-4456
(225) 336-4458
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY004535IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1268194
—
LA
01
—
2034893
PK
—
Enumeration date
12/26/2006
Last updated
06/16/2014
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