Provider Demographics
NPI:1427365600
Name:SHAMROCK STREET PHARMACY
Entity Type:Organization
Organization Name:SHAMROCK STREET PHARMACY
Other - Org Name:CENTRAL LA STATE HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:S
Authorized Official - Last Name:LINZAY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHARMACIS
Authorized Official - Phone:318-484-6665
Mailing Address - Street 1:242 WEST SHAMROCK STREET
Mailing Address - Street 2:UNIT 2, ROOM 120
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-6439
Mailing Address - Country:US
Mailing Address - Phone:318-484-6665
Mailing Address - Fax:318-484-6483
Practice Address - Street 1:242 WEST SHAMROCK STREET
Practice Address - Street 2:UNIT 2, ROOM 120
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6439
Practice Address - Country:US
Practice Address - Phone:318-484-6665
Practice Address - Fax:318-484-6483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL LA STATE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-09
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY-006280-INX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health