Healthcare Provider Details

I. General information

NPI: 1992151781
Provider Name (Legal Business Name): PRESCRIPTION SHOPPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2991 CYPRESS ST
WEST MONROE LA
71291-5337
US

IV. Provider business mailing address

2991 CYPRESS ST
WEST MONROE LA
71291-5337
US

V. Phone/Fax

Practice location:
  • Phone: 318-396-1985
  • Fax: 318-396-1941
Mailing address:
  • Phone: 318-396-1985
  • Fax: 318-396-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY.007293-IR
License Number StateLA

VIII. Authorized Official

Name: AMY PLEASANT
Title or Position: OWNER
Credential:
Phone: 318-396-1985