Provider Demographics
NPI:1851337877
Name:ABBEVILLE GENERAL HOSP PHCY
Entity Type:Organization
Organization Name:ABBEVILLE GENERAL HOSP PHCY
Other - Org Name:ABBEVILLE GENERAL HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHCY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-898-6482
Mailing Address - Street 1:118 N HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4039
Mailing Address - Country:US
Mailing Address - Phone:337-893-5466
Mailing Address - Fax:337-893-2801
Practice Address - Street 1:118 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4039
Practice Address - Country:US
Practice Address - Phone:337-898-6482
Practice Address - Fax:337-898-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.000002-HOS3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2029970OtherPK
LA1733741Medicaid
190034Medicare ID - Type Unspecified