Provider Demographics
NPI:1003964669
Name:FELICIANA PHARMACY INC
Entity Type:Organization
Organization Name:FELICIANA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HARUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-635-3700
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-0578
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7189 U S HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:ST FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775
Practice Address - Country:US
Practice Address - Phone:225-635-3700
Practice Address - Fax:225-635-3491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LA0003653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1911204OtherOTHER ID NUMBER-COMMERCIAL NUMBER
LA1215619Medicaid
1911204OtherOTHER ID NUMBER