Organization
MONTGOMERY PHARMACY LLC
Active
Other names
MONTGOMERY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
VINCE BARTLEY RPH (OWNER)
(318) 646-6877
Entity
Organization
Contact information
Practice address
1101 CADDO ST, MONTGOMERY, LA 71454
(318) 646-6877
(318) 646-6800
Mailing address
PO BOX 36, MONTGOMERY, LA 71454-0036
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY005153IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1270989
—
LA
01
—
2035172
PK
—
Enumeration date
11/11/2005
Last updated
06/28/2016
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