Healthcare Provider Details

I. General information

NPI: 1609495324
Provider Name (Legal Business Name): 180 FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 12/15/2024
Certification Date: 12/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9418 BROOKLINE AVE STE C
BATON ROUGE LA
70809-1428
US

IV. Provider business mailing address

9418 BROOKLINE AVE STE C
BATON ROUGE LA
70809-1428
US

V. Phone/Fax

Practice location:
  • Phone: 225-390-6963
  • Fax: 225-650-7414
Mailing address:
  • Phone: 225-249-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROD ROYAL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 225-249-0079