Provider Demographics
NPI:1215012364
Name:FAMILY PHARMACY SERVICE, INC
Entity Type:Organization
Organization Name:FAMILY PHARMACY SERVICE, INC
Other - Org Name:FIRST OPTION HOME INFUSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT, COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:KINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:337-234-1292
Mailing Address - Street 1:4906 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6962
Mailing Address - Country:US
Mailing Address - Phone:337-234-1292
Mailing Address - Fax:337-234-1326
Practice Address - Street 1:4906 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6962
Practice Address - Country:US
Practice Address - Phone:337-234-1292
Practice Address - Fax:337-234-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2419251F00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1259845Medicaid
LAG8720OtherBLUE CROSS DME
LA35488OtherBLUE CROSS PROVIDER NUMBE
LA1259845Medicaid