1194810101 NPI number — BARRERA BOUDREAUX & CASTELLON INC

Table of content: (NPI 1194810101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194810101 NPI number — BARRERA BOUDREAUX & CASTELLON INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRERA BOUDREAUX & CASTELLON INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
C & G PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194810101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9311 JEFFERSON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER RIDGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-738-2277
Provider Business Mailing Address Fax Number:
504-738-2281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9311 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVER RIDGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-738-2277
Provider Business Practice Location Address Fax Number:
504-738-2281
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIOLINO
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
SECRETARY TREASURER
Authorized Official Telephone Number:
504-738-2277

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  3927IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1915670 . This is a "NABP" identifier . This identifiers is of the category "OTHER".




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