Provider Demographics
NPI:1801918081
Name:NORTH LOUISIANA ST. VINCENT DEPAUL COMMUNITY PHARMACY
Entity type:Organization
Organization Name:NORTH LOUISIANA ST. VINCENT DEPAUL COMMUNITY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:BIGLANE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-387-6415
Mailing Address - Street 1:502 GRAMMONT ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7515
Mailing Address - Country:US
Mailing Address - Phone:318-387-7868
Mailing Address - Fax:318-324-9425
Practice Address - Street 1:502 GRAMMONT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7515
Practice Address - Country:US
Practice Address - Phone:318-387-7868
Practice Address - Fax:318-324-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4211CH251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable