MEDICARE: ELAYN HUNT CORRECTIONAL CENTER

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1730889296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELAYN HUNT CORRECTIONAL CENTER

Provider Business Mailing Address
First Line	:	6925 HIGHWAY 74
Second Line	:
City	:	SAINT GABRIEL
State	:	LA
Zip	:	70776-4706
Country	:	US
Telephone Number	:	225-319-4546
Fax Number	:	225-319-4254

Provider Business Practice Location Address
First Line	:	6925 HIGHWAY 74
Second Line	:
City	:	SAINT GABRIEL
State	:	LA
Zip	:	70776-4706
Country	:	US
Telephone Number	:	225-319-4546
Fax Number	:	225-319-4254

Authorized Official
Title or Position	:	PHARMACY DIRECTOR
Name	:	JONATHAN TRAVIS
Credential	:
Telephone Number	:	225-319-4546

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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