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General NPI Number Information
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NPI Number | 1467755264
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Entity Type | Organization
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Legal Business Name | CCC PHARMACY LLC
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 180 WINDERMERE BLVD
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3535
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Country | US
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Telephone | 318-445-8770
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Fax | 318-445-8979
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Provider Business Mailing Address
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Address Line | 180 WINDERMERE BLVD
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3535
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Country | US
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Telephone | 318-445-8770
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Fax | 318-445-8979
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Authorized Official
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Title or Position | MANAGER
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Name | MR. KEVIN PAUL ROBICHAUX
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Credential |
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Telephone | 318-445-8770
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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 | PHY-0622IR
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PHY006277-IR
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License Number State | LA
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