Provider Demographics
NPI:1447685979
Name:ST MARTIN PARISH CHC PHARMACY
Entity type:Organization
Organization Name:ST MARTIN PARISH CHC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-376-6868
Mailing Address - Street 1:317 DERNIER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-3809
Mailing Address - Country:US
Mailing Address - Phone:337-342-2566
Mailing Address - Fax:
Practice Address - Street 1:317 DERNIER ST
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-3809
Practice Address - Country:US
Practice Address - Phone:337-342-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy