Provider Demographics
NPI:1992054936
Name:GREATER BATON ROUGE PHARMACY
Entity type:Organization
Organization Name:GREATER BATON ROUGE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGWABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-579-9393
Mailing Address - Street 1:7855 HOWELL BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807
Mailing Address - Country:US
Mailing Address - Phone:281-579-9393
Mailing Address - Fax:281-579-3365
Practice Address - Street 1:7855 HOWELL BLVD
Practice Address - Street 2:STE 160
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807
Practice Address - Country:US
Practice Address - Phone:281-579-9393
Practice Address - Fax:281-579-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1936484OtherNCPDP PROVIDER IDENTIFICATION NUMBER