1114575354 NPI number — LAGNIAPPE PHARMACY 6, LLC

Table of content: (NPI 1114575354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114575354 NPI number — LAGNIAPPE PHARMACY 6, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAGNIAPPE PHARMACY 6, 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:
Provider Other Organization Name Type Code:
6
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:
1114575354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 S UNION ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPELOUSAS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70570-5745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-948-7703
Provider Business Mailing Address Fax Number:
337-948-9975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 S UNION ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPELOUSAS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70570-5745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-948-7703
Provider Business Practice Location Address Fax Number:
337-948-9975
Provider Enumeration Date:
08/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MANAGING MEMBER
Authorized Official Telephone Number:
225-810-7778

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1942108 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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