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General NPI Number Information
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NPI Number | 1407282585
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Entity Type | Organization
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Legal Business Name | FOUNTAIN PARK PHARMACY INC.
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 1901 MANHATTAN BLVD BUILDING F SUITE 104
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City | HARVEY
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State | LA
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Zip | 70058-3582
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Country | US
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Telephone | 504-434-4777
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Fax | 504-309-8031
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Provider Business Mailing Address
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Address Line | 1901 MANHATTAN BLVD BUILDING F SUITE 104
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City | HARVEY
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State | LA
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Zip | 70058-3582
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Country | US
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Telephone | 504-434-4777
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Fax | 504-309-8031
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | JO STEPHANIE CULOTTA
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Credential | PHARMACIST
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Telephone | 504-434-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY007141IR
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | LA1845
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH27207
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5277
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PHNR000702
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 14022/7.1
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License Number State | MS
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Taxonomy #7
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 15677
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License Number State | SC
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Taxonomy #8
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 22-44626
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License Number State | KS
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Taxonomy #9
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 114250
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License Number State | AL
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