Organization
MEDIC PHARMACY OF BASTROP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM GARY GRAYSON R.PH. (OWNER)
(318) 665-4414
Entity
Organization
Contact information
Practice address
601 HIGHWAY 2, STERLINGTON, LA 71280-3002
(318) 665-4414
(318) 665-0770
Mailing address
601 HIGHWAY 2, STERLINGTON, LA 71280-3002
(318) 665-4414
(318) 665-0770
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
4116IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1266523
—
LA
Enumeration date
12/06/2006
Last updated
02/12/2014
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