MEDICARE: LOUISIANA EXPRESS PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	3555-IR	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326122987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA EXPRESS PHARMACY

Provider Business Mailing Address
First Line	:	4560 NORTH BLVD
Second Line	:	SUITE 102
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4043
Country	:	US
Telephone Number	:	225-924-2484
Fax Number	:	225-926-4713

Provider Business Practice Location Address
First Line	:	4560 NORTH BLVD
Second Line	:	SUITE 102
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4043
Country	:	US
Telephone Number	:	225-924-2484
Fax Number	:	225-926-4713

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MRS. KAREN WESTON
Credential	:
Telephone Number	:	225-924-2484

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	12/07/2012

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Directions to “LOUISIANA EXPRESS PHARMACY ” Practice Location

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