Provider Demographics
NPI:1316037054
Name:PRESCRIPTION SPECIALTIES,LLC
Entity type:Organization
Organization Name:PRESCRIPTION SPECIALTIES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-562-7979
Mailing Address - Street 1:4070 NELSON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2444
Mailing Address - Country:US
Mailing Address - Phone:337-562-7979
Mailing Address - Fax:337-562-2343
Practice Address - Street 1:4070 NELSON RD
Practice Address - Street 2:STE 200
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2444
Practice Address - Country:US
Practice Address - Phone:337-562-7979
Practice Address - Fax:337-562-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4478-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1268518Medicaid
LA3870500001Medicare ID - Type UnspecifiedPROVIDER NUMBER