Provider Demographics
NPI:1053655993
Name:CHRIS PHARMACY & GIFTS OF PORT VINCENT LLC
Entity Type:Organization
Organization Name:CHRIS PHARMACY & GIFTS OF PORT VINCENT LLC
Other - Org Name:CHRIS' PHARMACY IN PORT VINCENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-573-4578
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-0328
Mailing Address - Country:US
Mailing Address - Phone:225-267-4350
Mailing Address - Fax:225-267-4357
Practice Address - Street 1:18590 LA HIGHWAY 16 STE 2
Practice Address - Street 2:
Practice Address - City:PORT VINCENT
Practice Address - State:LA
Practice Address - Zip Code:70726-8066
Practice Address - Country:US
Practice Address - Phone:225-698-6888
Practice Address - Fax:225-698-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY006627IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138026OtherPK
LA2201808Medicaid