Provider Demographics
NPI:1104397900
Name:GRETNA XPRESS PHARMACY
Entity type:Organization
Organization Name:GRETNA XPRESS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:JD, MPA, BA
Authorized Official - Phone:504-284-9033
Mailing Address - Street 1:1620 BELLE CHASSE HIGHWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7057
Mailing Address - Country:US
Mailing Address - Phone:504-368-5977
Mailing Address - Fax:504-368-5978
Practice Address - Street 1:1620 BELLE CHASSE HIGHWAY
Practice Address - Street 2:SUITE A
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7057
Practice Address - Country:US
Practice Address - Phone:504-368-5977
Practice Address - Fax:504-368-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2207075Medicaid