Organization
MANSURA DRUGSTORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA B NEYLAND (OWNER)
(318) 964-2104
Entity
Organization
Contact information
Practice address
2043 LEGLISE ST, MANSURA, LA 71350-4501
(318) 964-2104
(318) 964-5268
Mailing address
2043 LEGLISE ST, MANSURA, LA 71350-4501
(318) 964-2104
(318) 964-5268
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
CDS.041726-PHY
LA
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006525-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2202138
—
LA
Enumeration date
08/30/2006
Last updated
08/19/2013
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