Provider Demographics
NPI:1184660573
Name:BROWN MORRIS PHARMACY INC
Entity Type:Organization
Organization Name:BROWN MORRIS PHARMACY INC
Other - Org Name:BROWN MORRIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:985-229-6210
Mailing Address - Street 1:717 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-2601
Mailing Address - Country:US
Mailing Address - Phone:985-229-6210
Mailing Address - Fax:985-229-3131
Practice Address - Street 1:717 AVENUE G
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:LA
Practice Address - Zip Code:70444-2601
Practice Address - Country:US
Practice Address - Phone:985-229-6210
Practice Address - Fax:985-229-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
LA0042033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1906518OtherNCPDP PROVIDER IDENTIFICATION NUMBER
LA1267091Medicaid
1906518OtherNCPDP PROVIDER IDENTIFICATION NUMBER