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General NPI Number Information
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NPI Number | 1649218728
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Entity Type | Organization
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Legal Business Name | NORTHEAST LA PHARMACY
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 8860 QUIMPER PL SUITE 100
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City | SHREVEPORT
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State | LA
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Zip | 71105-5686
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Country | US
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Telephone | 318-797-9517
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Fax | 318-212-0057
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Provider Business Mailing Address
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Address Line | 8860 QUIMPER PL SUITE 100
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City | SHREVEPORT
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State | LA
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Zip | 71105-5686
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Country | US
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Telephone | 318-797-9517
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Fax | 318-212-0057
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Authorized Official
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Title or Position | REGIONAL DIRECTOR OF OPERATIONS-NOR
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Name | DOUGLAS ROBICHAUX
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Credential | RPH
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Telephone | 318-797-9517
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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 | PHY005546IR
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License Number State | LA
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