Organization
MANGHAM RX DRUGS, INC
Active
Other names
MANGHAM RX
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID P GIBSON RPH (PRES)
(318) 248-2345
Entity
Organization
Contact information
Practice address
104 LOUISIANA ST, MANGHAM, LA 71259
(318) 248-2345
(318) 248-3651
Mailing address
PO BOX 207, MANGHAM, LA 71259-0207
(318) 248-2345
(318) 248-3651
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
4311
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1267422
—
LA
01
—
1919616
NCPDP
LA
01
—
4311
PHARMACY STATE ID
LA
01
—
WBJS813
CCR
LA
Enumeration date
04/19/2006
Last updated
03/07/2023
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