Provider Demographics
NPI:1477616274
Name:MEDICAL PHARMACY INC.
Entity Type:Organization
Organization Name:MEDICAL PHARMACY INC.
Other - Org Name:MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LETARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-654-8383
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-0475
Mailing Address - Country:US
Mailing Address - Phone:225-654-8383
Mailing Address - Fax:225-654-9366
Practice Address - Street 1:6400 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4039
Practice Address - Country:US
Practice Address - Phone:225-654-8383
Practice Address - Fax:225-654-9366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2207296Medicaid
LA2207296Medicaid
MS01523311Medicaid
LA0422030001Medicare ID - Type UnspecifiedPROVIDER NUMBER