Provider Demographics
NPI:1073733325
Name:STANOCOLA EMPLOYEES MEDICAL & HOSPITAL ASSOCIATION, INC
Entity Type:Organization
Organization Name:STANOCOLA EMPLOYEES MEDICAL & HOSPITAL ASSOCIATION, INC
Other - Org Name:STANOCOLA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEDOUX
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASTANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-952-8730
Mailing Address - Street 1:16777 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3254
Mailing Address - Country:US
Mailing Address - Phone:225-926-7200
Mailing Address - Fax:225-952-8502
Practice Address - Street 1:16777 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3254
Practice Address - Country:US
Practice Address - Phone:225-926-7200
Practice Address - Fax:225-952-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC001065-1R3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1267961Medicaid
LAC001065-1ROtherSTATE LICENSE
5F900Medicare ID - Type Unspecified