1306223342 NPI number — EXPRESSWAY PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306223342 NPI number — EXPRESSWAY PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXPRESSWAY 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:
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:
1306223342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 WESTBANK EXPY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRETNA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70053-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-302-0987
Provider Business Mailing Address Fax Number:
504-302-0066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 WESTBANK EXPY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70053-5616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-302-0987
Provider Business Practice Location Address Fax Number:
504-302-0066
Provider Enumeration Date:
04/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LUU
Authorized Official First Name:
JOHNNY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER/OWNER
Authorized Official Telephone Number:
504-939-1176

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY.007128-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: 2203738 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2151695 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com