Provider Demographics
NPI:1235381674
Name:FOURCO, INC
Entity Type:Organization
Organization Name:FOURCO, INC
Other - Org Name:FOURNET'S PHARMACY PATTERSON AND HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:F
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:FOURNET
Authorized Official - Suffix:JR
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:337-828-3392
Mailing Address - Fax:337-828-3414
Practice Address - Street 1:516 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:LA
Practice Address - Zip Code:70392
Practice Address - Country:US
Practice Address - Phone:985-395-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOURCO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5283332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1216364Medicaid
LA1216364Medicaid
LA4999340003Medicare PIN
LA=========0OtherBLUE CROSS OF LOUISIANA