Organization
LIL BOOS CORNER STORE LLC
Active
Other names
Lil Boos Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MADDOX IV (OWNER)
(318) 793-2028
Entity
Organization
Contact information
Practice address
415 ST. CLAIR RD. STE. C, BOYCE, LA 71409
(318) 793-2028
(859) 594-6639
Mailing address
415 ST. CLAIR ROAD; SUITE C, BOYCE, LA 71409
(318) 793-2028
(859) 594-6639
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007439-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2168053
PK
—
05
—
2204980
—
LA
Enumeration date
02/24/2017
Last updated
07/18/2023
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