Provider Demographics
NPI:1356484414
Name:LARROQUE PHARMACY INC
Entity Type:Organization
Organization Name:LARROQUE PHARMACY INC
Other - Org Name:LARROQUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:LARROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-276-5001
Mailing Address - Street 1:1305 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEANERETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70544-3640
Mailing Address - Country:US
Mailing Address - Phone:337-276-5001
Mailing Address - Fax:337-276-4202
Practice Address - Street 1:1305 MAIN ST
Practice Address - Street 2:
Practice Address - City:JEANERETTE
Practice Address - State:LA
Practice Address - Zip Code:70544-3640
Practice Address - Country:US
Practice Address - Phone:337-276-5001
Practice Address - Fax:337-276-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY002587IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1260495Medicaid
2028749OtherPK
2028749OtherPK