Provider Demographics
NPI:1144221565
Name:CHRISTUS HEALTH CENTRAL LOUISIANA
Entity Type:Organization
Organization Name:CHRISTUS HEALTH CENTRAL LOUISIANA
Other - Org Name:CHRISTUS CABRINI INCARNATE WORD COMMUNITY PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REGIONAL PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-448-6701
Mailing Address - Street 1:3000 S MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2927
Mailing Address - Country:US
Mailing Address - Phone:318-483-7337
Mailing Address - Fax:318-528-6436
Practice Address - Street 1:3000 S MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-2927
Practice Address - Country:US
Practice Address - Phone:318-483-7337
Practice Address - Fax:318-528-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.006833-IR3336C0003X, 3336C0003X
LA234282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2202707Medicaid
LA1720208Medicaid