Organization
MABILES CORNER PHARMACY INC
Active
Other names
MABILES CORNER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE MABILE (PRES)
(318) 932-5727
Entity
Organization
Contact information
Practice address
100 GULF ST, COUSHATTA, LA 71019-9014
(318) 932-5727
(318) 932-5630
Mailing address
PO BOX 609, COUSHATTA, LA 71019-0609
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY-004694-IR
LA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1273929
—
LA
01
—
1902762
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/24/2006
Last updated
08/09/2019
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