Provider Demographics
NPI:1083629620
Name:NICK-NARD INC
Entity Type:Organization
Organization Name:NICK-NARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-599-2147
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:PINE PRAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70576-0770
Mailing Address - Country:US
Mailing Address - Phone:337-599-2147
Mailing Address - Fax:
Practice Address - Street 1:10600 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:PINE PRAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70576
Practice Address - Country:US
Practice Address - Phone:337-599-2147
Practice Address - Fax:337-599-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
LAPHY005049IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2031159OtherPK
LA1270768Medicaid