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NPI Code Detail

MEDICARE: BATON ROUGE SPECIALTY PHARMACY

MEDICARE: BATON ROUGE SPECIALTY 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
13336C0003XCommunity/Retail Pharmacy
2333600000XPharmacy
33336C0002XClinic Pharmacy4592IRLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11929996OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801940259
Entity Type Code : Organization
Provider Name (Legal Business Name) : BATON ROUGE SPECIALTY PHARMACY
Provider Business Mailing Address
First Line : 748 CHEVELLE DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-6503
Country : US
Telephone Number : 225-929-9912
Fax Number : 225-929-9948
Provider Business Practice Location Address
First Line : 748 CHEVELLE DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-6503
Country : US
Telephone Number : 225-929-9912
Fax Number : 225-929-9948
Authorized Official
Title or Position : PIC
Name : LIEM NGUYEN
Credential :
Telephone Number : 225-929-9912
Provider Enumeration Date : 01/23/2007
Last Update Date : 05/04/2017

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Practice Location Address:
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1487736773 — NATALIE H OVERALL
Practice Location Address:
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Practice Location Address:
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Directions to “BATON ROUGE SPECIALTY PHARMACY ” Practice Location

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