Organization
GORDON SMITH PHARMACY
Active
Other names
The Drugstore
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID WAYNE NAGEM RPH CCN (PHARMACIST IN CHARGE)
(318) 428-3212
Entity
Organization
Contact information
Practice address
212 MAIN STREET, OAK GROVE, LA 71263-1515
(318) 428-3212
(318) 428-7755
Mailing address
PO BOX 1515, OAK GROVE, LA 71263-1515
(318) 428-3212
(318) 428-7755
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
428 IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123949
—
LA
01
—
1909843
NARP
—
Enumeration date
01/02/2007
Last updated
06/25/2008
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