Healthcare Provider Details

I. General information

NPI: 1669921672
Provider Name (Legal Business Name): FAMILYRX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 PAUL MAILLARD RD STE C
LULING LA
70070
US

IV. Provider business mailing address

1772 CANAL BLVD
THIBODAUX LA
70301-5238
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-6213
  • Fax: 985-785-6575
Mailing address:
  • Phone: 985-447-3746
  • Fax: 985-449-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY.007424-IR
License Number StateLA

VIII. Authorized Official

Name: LISA PRESTENBACH
Title or Position: MEMBER
Credential:
Phone: 985-447-3746