Healthcare Provider Details

I. General information

NPI: 1215012364
Provider Name (Legal Business Name): FAMILY PHARMACY SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 AMBASSADOR CAFFERY PKWY SUITE 100
LAFAYETTE LA
70508-6962
US

IV. Provider business mailing address

4906 AMBASSADOR CAFFERY PKWY SUITE 100
LAFAYETTE LA
70508-6962
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-1292
  • Fax: 337-234-1326
Mailing address:
  • Phone: 337-234-1292
  • Fax: 337-234-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2419
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number2419
License Number StateLA

VIII. Authorized Official

Name: MR. KENNETH G KINGSTON
Title or Position: SR VICE PRESIDENT, COO
Credential: P.D.
Phone: 337-234-1292