Provider Demographics
NPI:1528111838
Name:CENTRAMED RADIOPHARMACY, LLC
Entity type:Organization
Organization Name:CENTRAMED RADIOPHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, BCNP
Authorized Official - Phone:318-323-3673
Mailing Address - Street 1:348 DESIARD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7429
Mailing Address - Country:US
Mailing Address - Phone:318-323-3673
Mailing Address - Fax:
Practice Address - Street 1:348 DESIARD ST
Practice Address - Street 2:SUITE C
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7429
Practice Address - Country:US
Practice Address - Phone:318-323-3673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5695-NU3336N0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336N0007XSuppliersPharmacyNuclear Pharmacy