Provider Demographics
NPI:1194902122
Name:PF SPAM LLC
Entity type:Organization
Organization Name:PF SPAM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-878-4401
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-0860
Mailing Address - Country:US
Mailing Address - Phone:985-878-6622
Mailing Address - Fax:985-878-6619
Practice Address - Street 1:54033 HIGHWAY 1062
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-3538
Practice Address - Country:US
Practice Address - Phone:985-878-6622
Practice Address - Fax:985-878-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY.005922-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2035600OtherPK
LA1219827Medicaid