MEDICARE: FAMILY PHARMACY SERVICE, INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	2419	LA
2	251F00000X	Home Infusion Agency	2419	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G8720	OTHER	LA	BLUE CROSS DME
3	35488	OTHER	LA	BLUE CROSS PROVIDER NUMBE

General Provider Information

NPI Number	:	1215012364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHARMACY SERVICE, INC

Provider Business Mailing Address
First Line	:	4906 AMBASSADOR CAFFERY PKWY
Second Line	:	SUITE 100
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6962
Country	:	US
Telephone Number	:	337-234-1292
Fax Number	:	337-234-1326

Provider Business Practice Location Address
First Line	:	4906 AMBASSADOR CAFFERY PKWY
Second Line	:	SUITE 100
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6962
Country	:	US
Telephone Number	:	337-234-1292
Fax Number	:	337-234-1326

Authorized Official
Title or Position	:	SR VICE PRESIDENT, COO
Name	:	MR. KENNETH G KINGSTON
Credential	:	P.D.
Telephone Number	:	337-234-1292

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	06/27/2008

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