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Contact Information

LIL BOOS CORNER STORE LLC
415 ST. CLAIR RD. STE. C
BOYCE, LA71409
 Phone: 318-793-2028
 Fax: 859-594-6639
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for LIL BOOS CORNER STORE LLC

NPI # 1639619653
LBN Legal business name LIL BOOS CORNER STORE LLC
Authorized official ROBERT MADDOX IV - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/24/2017
Last updated 07/18/2023 - About 3 years ago
Identifiers
LA License # PHY.007439-IR
LA Medicaid 2204980
Other 2168053 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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