Provider Demographics
NPI:1073981734
Name:MEADOWCREST PHARMACY LLC
Entity Type:Organization
Organization Name:MEADOWCREST PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:504-323-2350
Mailing Address - Street 1:866 MARLENE DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7642
Mailing Address - Country:US
Mailing Address - Phone:504-323-2350
Mailing Address - Fax:
Practice Address - Street 1:151 MEADOWCREST ST # A-1
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5256
Practice Address - Country:US
Practice Address - Phone:504-323-2350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7176-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7176-IROtherLOUISIANA BOARD OF PHARMACY
LA7176-IROtherLOUISIANA BOARD OF PHARMACY