Provider Demographics
NPI:1164891420
Name:ALBERTSONS PHARMACY
Entity Type:Organization
Organization Name:ALBERTSONS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-7815
Mailing Address - Street 1:2265 S MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3052
Mailing Address - Country:US
Mailing Address - Phone:318-445-7815
Mailing Address - Fax:
Practice Address - Street 1:2265 S MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3052
Practice Address - Country:US
Practice Address - Phone:318-445-7815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11900183500000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty