1003237827 NPI number — SOUTHEAST COMMUNITY HEALTH SYSTEMS PHARMACY

Table of content: MRS. STACY MARIE RIVERS PTA (NPI 1174327688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003237827 NPI number — SOUTHEAST COMMUNITY HEALTH SYSTEMS PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEAST COMMUNITY HEALTH SYSTEMS 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:
1003237827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O BOX 770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZACHARY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-306-2087
Provider Business Mailing Address Fax Number:
225-209-2055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30575 OLD BATON ROUGE HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-8350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-306-2087
Provider Business Practice Location Address Fax Number:
225-209-2055
Provider Enumeration Date:
12/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CYPRIAN
Authorized Official First Name:
ALECIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
225-306-2000

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , 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)





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