Basic Information
| Provider Information | |||||||||
| NPI: | 1780152157 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VERNON PARISH COMMUNITY HEALTH CENTER PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 806 JEFFERSON TER | ||||||||
| Address2: | |||||||||
| City: | NEW IBERIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705605727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373654945 | ||||||||
| FaxNumber: | 3373766860 | ||||||||
| Practice Location | |||||||||
| Address1: | 298 NOLAN TRACE PKWAY | ||||||||
| Address2: | |||||||||
| City: | LEESVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714463912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373920110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2018 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | DUMOND | ||||||||
| AuthorizedOfficialFirstName: | MONIQUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3373654945 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | Y | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.