Provider Demographics
NPI:1396859377
Name:IDEAL PHARMACY OF FRANKLINTON LLC
Entity Type:Organization
Organization Name:IDEAL PHARMACY OF FRANKLINTON LLC
Other - Org Name:IDEAL DRUG STORE OF FRANKLINTON LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-839-4668
Mailing Address - Street 1:808 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-3634
Mailing Address - Country:US
Mailing Address - Phone:985-839-4668
Mailing Address - Fax:985-839-4669
Practice Address - Street 1:808 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-3634
Practice Address - Country:US
Practice Address - Phone:985-839-4668
Practice Address - Fax:985-839-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
LA1936IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2031946OtherPK
LA1255874Medicaid
4151790001Medicare NSC