MEDICARE: CRESCENT CITY PHARMACEUTICALS 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	060303	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

General Provider Information

NPI Number	:	1578508164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESCENT CITY PHARMACEUTICALS INC

Provider Business Mailing Address
First Line	:	2716 PIEDMONT ST
Second Line	:
City	:	KENNER
State	:	LA
Zip	:	70062-4920
Country	:	US
Telephone Number	:	504-524-2254
Fax Number	:	504-528-9310

Provider Business Practice Location Address
First Line	:	2716 PIEDMONT ST
Second Line	:
City	:	KENNER
State	:	LA
Zip	:	70062-4920
Country	:	US
Telephone Number	:	504-524-2254
Fax Number	:	504-528-9310

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. FRANK LEON SMITH JR.
Credential	:	RPH
Telephone Number	:	504-524-2254

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	04/18/2023

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