Provider Demographics
NPI:1356332522
Name:ACKAL'S IBERIA PHARMACY INC
Entity Type:Organization
Organization Name:ACKAL'S IBERIA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOURET
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-364-7271
Mailing Address - Street 1:PO BOX 12311
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-2311
Mailing Address - Country:US
Mailing Address - Phone:337-364-7271
Mailing Address - Fax:337-369-9344
Practice Address - Street 1:1620 S HOPKINS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-5826
Practice Address - Country:US
Practice Address - Phone:337-364-7271
Practice Address - Fax:337-369-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC00008IR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1908322OtherNABP
LA1221350Medicaid
LA=========OtherTAX ID
LA1221350Medicaid