Organization
IBERIA COMPREHENSIVE CHC PHARMACY
Active
Other names
IBERIA COMPREHENSIVE CHC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
REGINALD BOUTTE RPH (PIC)
(337) 376-6868
Entity
Organization
Contact information
Practice address
806 JEFFERSON TER, NEW IBERIA, LA 70560-5727
(337) 376-6868
(337) 376-6866
Mailing address
806 JEFFERSON TER, NEW IBERIA, LA 70560-5727
(337) 376-6868
(337) 376-6866
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5987
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2035620
PK
—
Enumeration date
01/28/2008
Last updated
12/01/2021
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