=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760836381
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCHSNER PHARMACY AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2016
-----------------------------------------------------
Last Update Date | 07/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1405 JEFFERSON HWY STE A
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70121-2426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-842-7439
-----------------------------------------------------
Fax | 504-842-8477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1405 JEFFERSON HWY STE A
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70121-2426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-842-7439
-----------------------------------------------------
Fax | 504-842-8477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP AND COO
-----------------------------------------------------
Name | MICHAEL HULEFELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-842-5623
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY007294-RC
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------