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General NPI Number Information
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NPI Number | 1073109633
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Entity Type | Organization
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Legal Business Name | PARK PHARMACY LLC
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 4811 AMBASSADOR CAFFERY PKWY STE 101
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City | LAFAYETTE
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State | LA
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Zip | 70508-7266
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Country | US
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Telephone | 337-806-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 4811 AMBASSADOR CAFFERY PKWY STE 101
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City | LAFAYETTE
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State | LA
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Zip | 70508-7266
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Country | US
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Telephone | 337-806-9000
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | SHANE P PRIMEAUX
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Credential |
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Telephone | 337-806-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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