1699186015 NPI number — ARCHWAY APOTHECARY LLC

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 1699186015 NPI number — ARCHWAY APOTHECARY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCHWAY APOTHECARY 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:
1699186015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8705
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-801-0804
Provider Business Mailing Address Fax Number:
985-801-0801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42766 MERCHANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCHATOULA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-801-0804
Provider Business Practice Location Address Fax Number:
985-893-1845
Provider Enumeration Date:
05/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CAMP
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
OENER
Authorized Official Telephone Number:
985-801-0800

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY006821IR , registered in the state of LA ; 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: "Y" .

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

  • Identifier: 2145503 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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