Provider Demographics
NPI:1225512767
Name:LOUISIANA STATE UNIVERSITY
Entity Type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:225-485-3444
Mailing Address - Street 1:1 NORTH STADIUM DRIVE
Mailing Address - Street 2:BROUSSARD CENTER FOR ATHLETIC TRAINING
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70803
Mailing Address - Country:US
Mailing Address - Phone:225-578-0681
Mailing Address - Fax:225-578-3924
Practice Address - Street 1:1 NORTH STADIUM DRIVE
Practice Address - Street 2:BROUSSARD CENTER FOR ATHLETIC TRAINING
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70803
Practice Address - Country:US
Practice Address - Phone:225-578-0681
Practice Address - Fax:225-578-3924
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy