Organization
CLINIC PHARMACY OF MANGHAM LLC
Active
Other names
CLINIC PHARMACY OF MANGHAM LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KAYLA BRIDGES PD (OWNER/AO)
(318) 248-3338
Entity
Organization
Contact information
Practice address
252 HIGHWAY 132, MANGHAM, LA 71259-5268
(318) 248-3338
(318) 248-3399
Mailing address
252 HIGHWAY 132, MANGHAM, LA 71259-5268
(318) 248-3338
(318) 248-3399
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006681-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2035210
PK
—
05
—
2202081
—
LA
Enumeration date
03/27/2006
Last updated
03/03/2016
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