Organization
MEDIC SHOP PHARMACY
Active
Other names
Medic Shop Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SUSANN MILLEN (OWNER)
(985) 875-7515
Entity
Organization
Contact information
Practice address
1000 BUSINESS 190, COVINGTON, LA 70433-3285
(985) 875-7515
(985) 875-7544
Mailing address
1000 BUSINESS 190, COVINGTON, LA 70433-3285
(985) 875-7515
(985) 875-7544
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006069-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2118384
PK
—
Enumeration date
12/18/2008
Last updated
03/24/2017
Update your record
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