Healthcare Provider Details

I. General information

NPI: 1548823370
Provider Name (Legal Business Name): PBM SOLUTIONS COUSHATTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 PANTHER TRAIL DR
KINDER LA
70648
US

IV. Provider business mailing address

287 PANTHER TRAIL DR
KINDER LA
70648
US

V. Phone/Fax

Practice location:
  • Phone: 337-738-4170
  • Fax: 337-738-4171
Mailing address:
  • Phone: 337-738-4170
  • Fax: 337-738-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PHILIPPE PUCHEU
Title or Position: OWNER/MANAGER
Credential:
Phone: 337-738-4170