1457383499 NPI number — ARCADIA FAMILY PHARMACY LLC

Table of content: (NPI 1457383499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457383499 NPI number — ARCADIA FAMILY PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCADIA FAMILY PHARMACY LLC
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:
ARCADIA FAMILY 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:
1457383499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ALEXANDER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-238-2520
Provider Business Mailing Address Fax Number:
901-365-9820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 NORTH HAZEL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-263-3948
Provider Business Practice Location Address Fax Number:
318-263-7006
Provider Enumeration Date:
07/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAAD
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
318-259-7334

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1927548 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1264555 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1927548 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".