Provider Demographics
NPI:1518003722
Name:KIRBY PHARMACY SERVICES
Entity Type:Organization
Organization Name:KIRBY PHARMACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONVILLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-853-2885
Mailing Address - Street 1:7505 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4223
Mailing Address - Country:US
Mailing Address - Phone:985-853-2885
Mailing Address - Fax:985-853-2091
Practice Address - Street 1:7505 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4223
Practice Address - Country:US
Practice Address - Phone:985-853-2885
Practice Address - Fax:985-853-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6100-IR3336C0003X, 3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy