Provider Demographics
NPI:1124685763
Name:CHURCH POINT COMMUNITY PHARMACY
Entity type:Organization
Organization Name:CHURCH POINT COMMUNITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BODIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-684-1911
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-0130
Mailing Address - Country:US
Mailing Address - Phone:337-684-1911
Mailing Address - Fax:
Practice Address - Street 1:731 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-4109
Practice Address - Country:US
Practice Address - Phone:337-684-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1271918Medicaid