Organization
GULFCOAST PHARMACEUTICAL SPECIALTY
Active
Other names
GPS
Organization subpart
No
Provider details
NPI number
Authorized official
MYRA BLACK (OWNER)
(225) 647-4182
Entity
Organization
Contact information
Practice address
1039 E HIGHWAY 30, GONZALES, LA 70737-4757
(225) 647-4182
(225) 644-0460
Mailing address
PO BOX 489, GONZALES, LA 70707-0489
(225) 647-4182
(225) 644-0460
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
005084IR
LA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1270784
—
LA
01
—
1929972
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/20/2006
Last updated
01/17/2013
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