Healthcare Provider Details

I. General information

NPI: 1801940259
Provider Name (Legal Business Name): BATON ROUGE SPECIALTY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 CHEVELLE DR
BATON ROUGE LA
70806-6503
US

IV. Provider business mailing address

748 CHEVELLE DR
BATON ROUGE LA
70806-6503
US

V. Phone/Fax

Practice location:
  • Phone: 225-929-9912
  • Fax: 225-929-9948
Mailing address:
  • Phone: 225-929-9912
  • Fax: 225-929-9948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number4592IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LIEM NGUYEN
Title or Position: PIC
Credential:
Phone: 225-929-9912