Provider Demographics
NPI:1073528626
Name:TRIEL REGIONS PHARMACY
Entity Type:Organization
Organization Name:TRIEL REGIONS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARM ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LURTHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEATHAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-763-6259
Mailing Address - Street 1:9270 SIEGEN LN
Mailing Address - Street 2:STE 803
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1998
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9270 SIEGEN LN
Practice Address - Street 2:STE 803
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1998
Practice Address - Country:US
Practice Address - Phone:225-763-6259
Practice Address - Fax:225-763-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5581333600000X
3336C0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1211346Medicaid
1932638OtherOTHER ID NUMBER-COMMERCIAL NUMBER