Provider Demographics
NPI:1083791552
Name:MAYEAUX FAMILY PHARM
Entity Type:Organization
Organization Name:MAYEAUX FAMILY PHARM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAYEAUX
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:337-584-2256
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:911 MAIN ST
Mailing Address - City:ELTON
Mailing Address - State:LA
Mailing Address - Zip Code:70532-0177
Mailing Address - Country:US
Mailing Address - Phone:337-584-2256
Mailing Address - Fax:337-580-1195
Practice Address - Street 1:911 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELTON
Practice Address - State:LA
Practice Address - Zip Code:70532-0177
Practice Address - Country:US
Practice Address - Phone:337-584-2256
Practice Address - Fax:337-580-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10564183500000X
LA1467IR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1251186Medicaid
LA1251186Medicaid