Organization
ICARE JOHNSTON STREET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNA TERESA W ANDREPONT (MANAGING OFFICER)
(337) 233-4782
Entity
Organization
Contact information
Practice address
2039 JOHNSTON STREET, LAFAYETTE, LA 70503
(337) 233-4782
(337) 233-4783
Mailing address
2039 JOHNSTON STREET, LAFAYETTE, LA 70503
(337) 233-4782
(337) 233-4783
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
04/07/2014
Last updated
08/01/2014
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