Vital Care of Miss-Lou Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY.007013-IR Issued in LA

Legal business name

VITAL CARE OF MISS-LOU INC

Practice address

6280 Highway 129
Monterey, LA 71354-4072

Phone

(318) 386-2344

Fax

(318) 386-2366

NPI assigned

Jul 14, 2006

Organization subpart

No

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

Authorized official

Name

Charles Maier

Title

R.PH.

Phone

(318) 386-2344

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Lakeside Pharmacy & Gift Doing business as

Locations

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1619993300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37",
            "city": "MONTEREY",
            "state": "LA",
            "postal_code": "713540037",
            "telephone_number": "318-386-2344",
            "fax_number": "318-386-2366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6280 HIGHWAY 129",
            "city": "MONTEREY",
            "state": "LA",
            "postal_code": "713544072",
            "telephone_number": "318-386-2344",
            "fax_number": "318-386-2366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL CARE OF MISS-LOU INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2016-10-04",
        "status": "A",
        "authorized_official_last_name": "MAIER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "R.PH.",
        "authorized_official_telephone_number": "318-386-2344"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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.007013-IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2203754",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2033948",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Pharmacy & Gift",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Leigh Anne Bertelsen

• Community/Retail Pharmacy in Monterey, LA
• Providers in Monterey, 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 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.