Provider Demographics
NPI:1114086212
Name:ST MARGARETS PHARMACY SERVICES
Entity Type:Organization
Organization Name:ST MARGARETS PHARMACY SERVICES
Other - Org Name:ST MARGARETS PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-349-9411
Mailing Address - Street 1:4000 4TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2240
Mailing Address - Country:US
Mailing Address - Phone:504-349-9411
Mailing Address - Fax:504-349-9413
Practice Address - Street 1:4000 4TH ST
Practice Address - Street 2:STE B
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2240
Practice Address - Country:US
Practice Address - Phone:504-349-9411
Practice Address - Fax:504-349-9413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54803336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1274071Medicaid
1932133OtherNCPDP PROVIDER IDENTIFICATION NUMBER