Organization
VITAL CARE OF MISS-LOU INC
Active
Other names
Lakeside Pharmacy & Gift
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES MAIER (R.PH.)
(318) 386-2344
Entity
Organization
Contact information
Practice address
6280 HIGHWAY 129, MONTEREY, LA 71354-4072
(318) 386-2344
(318) 386-2366
Mailing address
PO BOX 37, MONTEREY, LA 71354-0037
(318) 386-2344
(318) 386-2366
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007013-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2033948
PK
—
05
—
2203754
—
LA
Enumeration date
07/14/2006
Last updated
10/04/2016
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