Provider Demographics
NPI:1073934733
Name:EXPRESS PHARMACY SOLUTIONS
Entity Type:Organization
Organization Name:EXPRESS PHARMACY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BURKENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-236-4030
Mailing Address - Street 1:1441 CANAL ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2714
Mailing Address - Country:US
Mailing Address - Phone:504-236-4030
Mailing Address - Fax:504-304-6229
Practice Address - Street 1:1441 CANAL ST
Practice Address - Street 2:STE. 201
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2714
Practice Address - Country:US
Practice Address - Phone:504-236-4030
Practice Address - Fax:504-304-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6800333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy