MEDICARE: PARKWAY PHARMACY SOUTH LLC

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

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	:	1508522459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKWAY PHARMACY SOUTH LLC

Provider Business Mailing Address
First Line	:	1666 RICHWOOD ROAD 1 STE 2
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-6892
Country	:	US
Telephone Number	:	318-734-0046
Fax Number	:	318-734-0014

Provider Business Practice Location Address
First Line	:	1666 RICHWOOD ROAD 1 STE 2
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-6892
Country	:	US
Telephone Number	:	318-734-0046
Fax Number	:	318-734-0014

Authorized Official
Title or Position	:	OWNER
Name	:	LATEEF ODEYEMI
Credential	:
Telephone Number	:	318-243-4748

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	10/18/2025

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Directions to “PARKWAY PHARMACY SOUTH LLC ” Practice Location

Language	Start Address	Practice Location

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