Provider Demographics
NPI:1225136252
Name:FOURCO INC
Entity Type:Organization
Organization Name:FOURCO INC
Other - Org Name:FOURNETS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNET
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:337-828-3392
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-0323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1524 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3723
Practice Address - Country:US
Practice Address - Phone:337-828-3392
Practice Address - Fax:337-828-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
LAPHY000379-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1216364Medicaid
1905302OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1905302OtherNCPDP PROVIDER IDENTIFICATION NUMBER