1538260658 NPI number — BEGNEAUD'S PHARMACY

Table of content: (NPI 1538260658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538260658 NPI number — BEGNEAUD'S PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEGNEAUD'S PHARMACY
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:
Provider Other Organization Name Type Code:
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:
1538260658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1164 COOLIDGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70503-2619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-234-9488
Provider Business Mailing Address Fax Number:
337-234-9480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1164 COOLIDGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503-2619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-234-9488
Provider Business Practice Location Address Fax Number:
337-234-9480
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GANUCHEAU
Authorized Official First Name:
LOUISE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
337-234-9488

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  15749 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183700000X , with the licence number: 1190 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 61-IR , 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: 1203351 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61-IR . This is a "PERMIT" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1902938 . This is a "NABP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: C000061-IR . This is a "CDS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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