Provider Demographics
NPI:1427010396
Name:DIABETIC PHARMACY CENTRE, LLC
Entity Type:Organization
Organization Name:DIABETIC PHARMACY CENTRE, LLC
Other - Org Name:DIABETIC PHARMACY CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEVILS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:225-248-0081
Mailing Address - Street 1:7970 JEFFERSON HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1207
Mailing Address - Country:US
Mailing Address - Phone:225-248-0081
Mailing Address - Fax:
Practice Address - Street 1:7970 JEFFERSON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1207
Practice Address - Country:US
Practice Address - Phone:225-248-0081
Practice Address - Fax:225-248-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5500333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1932183OtherNCPDP
LA1275051Medicaid
LA1275051Medicaid