Provider Demographics
NPI:1275074189
Name:PERKINS FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:PERKINS FAMILY PHARMACY LLC
Other - Org Name:PERKINS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-428-4344
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-0672
Mailing Address - Country:US
Mailing Address - Phone:318-428-4344
Mailing Address - Fax:318-490-8004
Practice Address - Street 1:803 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-2534
Practice Address - Country:US
Practice Address - Phone:318-428-4344
Practice Address - Fax:318-490-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
LAPHY.007470-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169115OtherPK