| Organization Name: | MEDIC PHARMACY OF BASTROP |
| NPI Number: | 1205815800 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM GARY GRAYSON (OWNER/PRESIDENT/PHARMACIST) |
| Mailing Address: | 1821 N Washington St Bastrop |
| State: | LA US |
| Postal Code: | 712202441 |
| Phone Number: | 3182813291 |
| Fax Number: | 3182813292 |
| NPI Enumeration Date: | 01/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 0304220001 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |