Provider Demographics
NPI:1699823690
Name:NATIONAL PHARMACY
Entity type:Organization
Organization Name:NATIONAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHRM MANG
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNNERY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:225-767-2044
Mailing Address - Street 1:10105 PARK ROWE CIR
Mailing Address - Street 2:STE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10105 PARK ROWE CIR
Practice Address - Street 2:STE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1688
Practice Address - Country:US
Practice Address - Phone:225-767-2044
Practice Address - Fax:225-767-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5491333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1272763Medicaid
1932169OtherOTHER ID NUMBER-COMMERCIAL NUMBER