MEDICARE: PARTNERS 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	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy	6205	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	2122787	OTHER		PK

General Provider Information

NPI Number	:	1982837365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNERS PHARMACY LLC

Provider Business Mailing Address
First Line	:	3915 KIRKMAN ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-3503
Country	:	US
Telephone Number	:	337-214-0420
Fax Number	:	337-312-1785

Provider Business Practice Location Address
First Line	:	3915 KIRKMAN ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-3503
Country	:	US
Telephone Number	:	337-214-0420
Fax Number	:	337-312-1785

Authorized Official
Title or Position	:	MANAGING OFFICER
Name	:	RICK DELRIE
Credential	:
Telephone Number	:	877-284-0255

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	03/27/2017

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Directions to “PARTNERS PHARMACY LLC ” Practice Location

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