Provider Demographics
NPI:1093728313
Name:CENLA PROFESSIONAL PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:CENLA PROFESSIONAL PHARMACY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-442-3282
Mailing Address - Street 1:610 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-442-3282
Mailing Address - Fax:318-442-2233
Practice Address - Street 1:610 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-442-3282
Practice Address - Fax:318-442-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1925013OtherNABP
LA52896OtherBLUE CROSS BLUE SHIELD
LA1261360Medicaid
LA52896OtherBLUE CROSS BLUE SHIELD