Provider Demographics
NPI:1356419022
Name:MOCK'S PHARMACY AND GIFTS, INC.
Entity type:Organization
Organization Name:MOCK'S PHARMACY AND GIFTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-396-1431
Mailing Address - Street 1:711 ARKANSAS RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5022
Mailing Address - Country:US
Mailing Address - Phone:318-396-1431
Mailing Address - Fax:318-396-1431
Practice Address - Street 1:711 ARKANSAS RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5022
Practice Address - Country:US
Practice Address - Phone:318-396-1431
Practice Address - Fax:318-396-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4434-IR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1268127Medicaid
LA4848560001Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #