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General NPI Number Information
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NPI Number | 1417487430
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Entity Type | Organization
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Legal Business Name | HIGHGATE APOTHECARY-101 LLC
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 141 LAKEVIEW CIR
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City | COVINGTON
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State | LA
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Zip | 70433-7513
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Country | US
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Telephone | 985-400-2428
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Fax | 985-400-2427
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Provider Business Mailing Address
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Address Line | 141 LAKEVIEW CIR
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City | COVINGTON
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State | LA
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Zip | 70433-7513
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Country | US
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Telephone | 985-400-2428
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Fax | 985-400-2427
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE/AO
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Name | ROBERT SCELFO
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Credential | RPH
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Telephone | 985-400-2428
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 007507
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License Number State | LA
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