MEDICARE: ST. AMANT FAMILY PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1013552942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. AMANT FAMILY PHARMACY LLC

Provider Business Mailing Address
First Line	:	1812 W THOMAS ST
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-2945
Country	:	US
Telephone Number	:	985-345-4767
Fax Number	:	985-345-4768

Provider Business Practice Location Address
First Line	:	12502 HIGHWAY 431
Second Line	:
City	:	SAINT AMANT
State	:	LA
Zip	:	70774-3418
Country	:	US
Telephone Number	:	225-644-7288
Fax Number	:	225-647-6639

Authorized Official
Title or Position	:	RPH,MANAGER,OWNER
Name	:	DANA ANTOON
Credential	:
Telephone Number	:	985-514-3173

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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