Provider Demographics
NPI:1194187591
Name:ST. VINCENT DE PAUL TRI PARISH PHARMACY
Entity Type:Organization
Organization Name:ST. VINCENT DE PAUL TRI PARISH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-688-3684
Mailing Address - Street 1:7385 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4021
Mailing Address - Country:US
Mailing Address - Phone:985-872-2253
Mailing Address - Fax:
Practice Address - Street 1:7385 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4021
Practice Address - Country:US
Practice Address - Phone:985-872-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.004673CH333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy