Organization
INCA ENTERPRISES INC
Active
Other names
MEDICS COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CLOVIS BURCH RPH (PRESIDENT)
(318) 865-0234
Entity
Organization
Contact information
Practice address
1847 LINE AVE, SHREVEPORT, LA 71101-4611
(318) 222-8477
(318) 222-8487
Mailing address
PO BOX 6119, SHREVEPORT, LA 71136-6119
(318) 865-0234
(318) 865-3972
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.003693-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1266957
—
LA
01
—
2034911
PK
—
Enumeration date
09/12/2006
Last updated
01/13/2017
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