Organization
COTTONPORT CORNER DRUG LLC
Active
Other names
Cottonport Corner Drug LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KIM WIXSON (MRS.)
(318) 253-2399
Entity
Organization
Contact information
Practice address
206 CHOUPIQUE LN, COTTONPORT, LA 71327-3757
(318) 876-3665
(318) 876-2429
Mailing address
206 CHOUPIQUE LN, COTTONPORT, LA 71327-3757
(318) 876-3665
(318) 876-2429
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006498-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134437
PK
—
05
—
2201336
—
LA
Enumeration date
03/02/2012
Last updated
04/13/2017
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