Organization
WILLOW PHARMACY INC
Active
Other names
Willow Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DARREN MARTIN (PIC)
(877) 558-7943
Entity
Organization
Contact information
Practice address
1519 HIGHWAY 22 W, MADISONVILLE CENTER SUITE 5, MADISONVILLE, LA 70447-9489
(985) 792-2391
(855) 848-3661
Mailing address
1519 HIGHWAY 22 W, MADISONVILLE CENTER SUITE 5, MADISONVILLE, LA 70447-9489
(985) 792-2391
(855) 848-3661
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006595-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137008
PK
—
Enumeration date
09/14/2012
Last updated
08/24/2016
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