Basic Information
| Provider Information | |||||||||
| NPI: | 1265757512 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DAUGHTERS OF CHARITY SERVICES PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 970 | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700590970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044820084 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 N CAUSEWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700015450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044820084 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2010 | ||||||||
| LastUpdateDate: | 09/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | GRIFFIN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 5042129502 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS | ||||||||
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| AuthorizedOfficialCredential: | CEO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | 3542IR | LA | N | Ambulatory Health Care Facilities | Clinic/Center | Health Service | 3336C0003X | 3542IR | LA | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.