Provider Demographics
NPI:1063447787
Name:MATTE'S PHARMACY INC
Entity type:Organization
Organization Name:MATTE'S PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MATTE
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-292-4570
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:LA
Mailing Address - Zip Code:71260-0017
Mailing Address - Country:US
Mailing Address - Phone:318-292-4570
Mailing Address - Fax:318-292-5606
Practice Address - Street 1:314 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:LA
Practice Address - Zip Code:71260
Practice Address - Country:US
Practice Address - Phone:318-292-4570
Practice Address - Fax:318-292-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.000711-IR332B00000X
LA711-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100523407Medicaid
LA1902798OtherNABP NUMBER
LA1200514Medicaid
LA0199010001Medicare ID - Type UnspecifiedMEDICARE