Willow Mina

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY.007400-IR Issued in LA

Legal business name

WILLOW MINA

Doing business as

WILLOW BARK PHARMACY

Practice address

606 Highway 20
Thibodaux, LA 70301-6255

Phone

(985) 633-2275

Fax

(985) 633-4703

NPI assigned

Oct 5, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Minh NguyenNPI 1750687851

Title

President

Phone

(985) 772-4088

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• WILLOW BARK PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Minh Van Nguyen, R.PH.

  • Pharmacist
  • Houma, LA
  • NPI 1750687851
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1235689977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 HIGHWAY 20",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703016255",
            "telephone_number": "985-633-2275",
            "fax_number": "985-633-4703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 HIGHWAY 20",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703016255",
            "telephone_number": "985-633-2275",
            "fax_number": "985-633-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW MINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-05",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "MINH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "985-772-4088"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY.007400-IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166319",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2204882",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILLOW BARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mercedes Williams, MS
• Rose M. Williams, MSW
• Kimberly Williamson, BSW
• Raegan Willis, ATC
• Willow Bend Family Services LLC
• Cherry Wilmore
• Sherry Marie Wilmore
• Wilson Transportation
• Jerome Wilson
• Dru Wintter, LMT

• Community/Retail Pharmacy in Thibodaux, LA
• Providers in Thibodaux, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.