Organization
DEEP SOUTH MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BANNISTER (MANAGER)
(318) 927-3523
Entity
Organization
Contact information
Practice address
311 CHISUM ST, SICILY ISLAND, LA 71368-4807
(318) 389-5807
Mailing address
PO BOX 38, SICILY ISLAND, LA 71368-0038
(318) 389-5807
(318) 389-5842
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2207385
—
LA
Enumeration date
03/20/2019
Last updated
12/07/2020
About Stedi
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