Provider Demographics
NPI:1194881466
Name:LOUVELLA H GRANGER
Entity type:Organization
Organization Name:LOUVELLA H GRANGER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHCST
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-981-8844
Mailing Address - Street 1:3810 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5259
Mailing Address - Country:US
Mailing Address - Phone:337-981-8844
Mailing Address - Fax:337-981-8884
Practice Address - Street 1:3810 AMBASSADOR CAFFERY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5259
Practice Address - Country:US
Practice Address - Phone:337-981-8844
Practice Address - Fax:337-981-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
LAPHY.005007-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2035103OtherPK