Provider Demographics
NPI:1427409127
Name:OCHSNER PHARMACY AND WELLNESS LLC
Entity Type:Organization
Organization Name:OCHSNER PHARMACY AND WELLNESS LLC
Other - Org Name:OCHSNER PHARMACY AND WELLNESS - KENNER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROVIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-842-8623
Mailing Address - Street 1:1405 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2426
Mailing Address - Country:US
Mailing Address - Phone:504-464-8250
Mailing Address - Fax:504-464-8251
Practice Address - Street 1:200 W ESPLANADE AVE STE 106
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2473
Practice Address - Country:US
Practice Address - Phone:504-464-8250
Practice Address - Fax:504-464-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY-007340-RC3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162242OtherPK