Provider Demographics
NPI:1528542669
Name:INTEGRATIVE PHARMACY AND WELLNESS, LLC
Entity type:Organization
Organization Name:INTEGRATIVE PHARMACY AND WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:225-831-1212
Mailing Address - Street 1:9026 JEFFERSON HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2432
Mailing Address - Country:US
Mailing Address - Phone:225-813-1212
Mailing Address - Fax:225-831-1259
Practice Address - Street 1:9026 JEFFERSON HWY STE 101
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2432
Practice Address - Country:US
Practice Address - Phone:225-813-1212
Practice Address - Fax:225-831-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty