Healthcare Provider Details

I. General information

NPI: 1366122608
Provider Name (Legal Business Name): EXPRESSWAY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WESTBANK EXPY
GRETNA LA
70053-5616
US

IV. Provider business mailing address

315 WESTBANK EXPY
GRETNA LA
70053-5616
US

V. Phone/Fax

Practice location:
  • Phone: 504-302-0987
  • Fax: 504-302-0066
Mailing address:
  • Phone: 504-302-0987
  • Fax: 504-302-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHNNY LUU
Title or Position: OWNER/PIC
Credential: PHARMD
Phone: 504-939-1176