1780152157 NPI number — VERNON PARISH COMMUNITY HEALTH CENTER PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780152157 NPI number — VERNON PARISH COMMUNITY HEALTH CENTER PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERNON PARISH COMMUNITY HEALTH CENTER PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780152157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 JEFFERSON TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW IBERIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70560-5727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-365-4945
Provider Business Mailing Address Fax Number:
337-376-6860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
298 NOLAN TRACE PKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446-3912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-392-0110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DUMOND
Authorized Official First Name:
MONIQUE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
337-365-4945

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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