Provider Demographics
NPI:1083080568
Name:OLLA PHARMACY
Entity Type:Organization
Organization Name:OLLA PHARMACY
Other - Org Name:BROOKS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-339-7913
Mailing Address - Street 1:104 MOUND ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343-2319
Mailing Address - Country:US
Mailing Address - Phone:318-339-7913
Mailing Address - Fax:318-339-7914
Practice Address - Street 1:104 MOUND ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71343
Practice Address - Country:US
Practice Address - Phone:318-339-7913
Practice Address - Fax:318-339-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY-007086-IR3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1264377Medicaid
LA1145730001Medicare UPIN