Organization
SS BOSSIER CITY LLC
Active
Other names
QVL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GARY CHAD COLLINS (CEO)
(214) 624-3050
Entity
Organization
Contact information
Practice address
3501 SEVERN AVE STE 3A, STE 3A, METAIRIE, LA 70002-3459
(504) 889-8483
(504) 889-8487
Mailing address
PO BOX 803493, DALLAS, TX 75380-3493
(214) 624-3073
(214) 989-7986
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5538IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1274992
—
LA
01
—
2035273
PK
—
Enumeration date
05/17/2006
Last updated
06/17/2014
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