=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932501038
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MBP GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2014
-----------------------------------------------------
Last Update Date | 06/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8138 OAK ST
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-324-4343
-----------------------------------------------------
Fax | 504-301-2950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8138 OAK ST
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70118-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-324-4343
-----------------------------------------------------
Fax | 504-301-2950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | MATTHEW PLAISANCE
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 504-324-4343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------