Organization
MONTGOMERY PHARMACY LLC
Active
Other names
Grant Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VINCE BARTLEY (R.PH/OWNER)
(318) 646-6877
Entity
Organization
Contact information
Practice address
19479 HIGHWAY 167, BENTLEY, LA 71407-3502
(318) 899-5066
(318) 899-5069
Mailing address
PO BOX 388, BENTLEY, LA 71407-0388
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006087-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2118752
PK
—
Enumeration date
02/12/2009
Last updated
01/20/2017
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