Provider Demographics
NPI:1114356896
Name:ALL SAINTS PHARMACY LLC
Entity Type:Organization
Organization Name:ALL SAINTS PHARMACY LLC
Other - Org Name:ALL SAINTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-443-1294
Mailing Address - Street 1:2124 38TH ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3510
Mailing Address - Country:US
Mailing Address - Phone:504-443-1294
Mailing Address - Fax:504-443-1982
Practice Address - Street 1:2124 38TH ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3510
Practice Address - Country:US
Practice Address - Phone:504-443-1294
Practice Address - Fax:504-443-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
LA0067733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142943OtherPK
LA2202324Medicaid