Provider Demographics
NPI:1336303429
Name:BOCAGE PHARMACY CENTRE INC
Entity Type:Organization
Organization Name:BOCAGE PHARMACY CENTRE INC
Other - Org Name:BOCAGE PHARMACY CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-364-2847
Mailing Address - Street 1:7150 JEFFERSON HWY
Mailing Address - Street 2:STE 680
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8128
Mailing Address - Country:US
Mailing Address - Phone:225-364-2847
Mailing Address - Fax:225-364-2852
Practice Address - Street 1:7150 JEFFERSON HWY
Practice Address - Street 2:STE 680
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8128
Practice Address - Country:US
Practice Address - Phone:225-364-2847
Practice Address - Fax:225-364-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY006047IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116838OtherPK
LA1234273Medicaid