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General NPI Number Information
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NPI Number | 1578796140
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Entity Type | Organization
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Legal Business Name | SLIDELL PHARMACY LLC
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 1201 ROBERT BLVD
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City | SLIDELL
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State | LA
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Zip | 70458
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Country | US
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Telephone | 985-288-0099
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Fax | 985-641-2677
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Provider Business Mailing Address
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Address Line | 1115 REBECCA REID DR
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City | SLIDELL
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State | LA
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Zip | 70461-2015
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Country | US
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Telephone | 985-641-2660
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Fax | 985-641-2677
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA MARIE BEI-PALERMO
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Credential | CPHT
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Telephone | 985-288-0099
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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 | 6166
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License Number State | LA
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