Provider Demographics
NPI:1407492184
Name:MARY BIRD PERKINS CANCER CENTER
Entity type:Organization
Organization Name:MARY BIRD PERKINS CANCER CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:COURVILLE
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-215-1321
Mailing Address - Street 1:4950 ESSEN LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3738
Mailing Address - Country:US
Mailing Address - Phone:225-215-1281
Mailing Address - Fax:225-215-1380
Practice Address - Street 1:10600 INDUSTRIAL DR STE B
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-5105
Practice Address - Country:US
Practice Address - Phone:318-716-7541
Practice Address - Fax:318-202-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACDS.067595-PHYOtherPHARMACY CDS LICENSE
LAPST.025224OtherPIC
LAPHY.008821-IROtherPHARMACY LICENSE
LAPIC.025224OtherPIC
LAPIC.023556OtherLOUISIANA BOARD OF PHARMACY