Provider Demographics
NPI:1235732686
Name:A-1 PHARMACY METAIRIE, L.L.C.
Entity Type:Organization
Organization Name:A-1 PHARMACY METAIRIE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF L.L.C.
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:LABORDE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:504-875-2330
Mailing Address - Street 1:PO BOX 8333
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70011-8333
Mailing Address - Country:US
Mailing Address - Phone:504-875-2330
Mailing Address - Fax:504-875-2331
Practice Address - Street 1:3501 SEVERN AVE STE 3A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3459
Practice Address - Country:US
Practice Address - Phone:504-875-2330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2203266Medicaid