Healthcare Provider Details

I. General information

NPI: 1003964669
Provider Name (Legal Business Name): FELICIANA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7189 U S HIGHWAY 61
ST FRANCISVILLE LA
70775
US

IV. Provider business mailing address

PO BOX 578
SAINT FRANCISVILLE LA
70775-0578
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-3700
  • Fax: 225-635-3491
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number000365
License Number StateLA

VIII. Authorized Official

Name: JAMES HARUEN
Title or Position: PRESIDENT
Credential:
Phone: 225-635-3700