Healthcare Provider Details

I. General information

NPI: 1255401022
Provider Name (Legal Business Name): CHITIMACHA PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 CHITIMACHA TRAIL
CHARENTON LA
70523
US

IV. Provider business mailing address

3231 CHITIMACHA TRAIL
CHARENTON LA
70523
US

V. Phone/Fax

Practice location:
  • Phone: 337-923-9955
  • Fax: 337-923-7791
Mailing address:
  • Phone: 337-923-9955
  • Fax: 337-923-7791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTIE NICOLE SOILEAU
Title or Position: CHIEF PHARMACIST
Credential: P.D.
Phone: 337-923-9955