Healthcare Provider Details

I. General information

NPI: 1487482782
Provider Name (Legal Business Name): PHARMA FUSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 PUJO STREET
LAKE CHARLES LA
70601-4365
US

IV. Provider business mailing address

518 PUJO STREET
LAKE CHARLES LA
70601-4365
US

V. Phone/Fax

Practice location:
  • Phone: 337-761-5397
  • Fax: 337-761-0831
Mailing address:
  • Phone: 337-761-5397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAJAL K ROY
Title or Position: SOLE MEMBER
Credential: PHARM.D.
Phone: 337-761-5397