Healthcare Provider Details

I. General information

NPI: 1245468313
Provider Name (Legal Business Name): NOAHS PHARMACY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W SAINT FRANCIS ST
BRUSLY LA
70719-2283
US

IV. Provider business mailing address

6572 S RIVER RD
BRUSLY LA
70719-2518
US

V. Phone/Fax

Practice location:
  • Phone: 225-749-8202
  • Fax: 225-749-8205
Mailing address:
  • Phone: 225-892-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number16122
License Number StateLA

VIII. Authorized Official

Name: MS. KIMBERLY MURPHY PAUL
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 225-892-7456