Provider Demographics
NPI:1477619740
Name:LOUISIANA PHARMACY LLC
Entity Type:Organization
Organization Name:LOUISIANA PHARMACY LLC
Other - Org Name:DRENNANS MEDICINE CHEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-885-0821
Mailing Address - Street 1:411 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2762
Mailing Address - Country:US
Mailing Address - Phone:903-885-0821
Mailing Address - Fax:903-885-8734
Practice Address - Street 1:2713 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4627
Practice Address - Country:US
Practice Address - Phone:318-396-6180
Practice Address - Fax:903-885-8734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
LA5720IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1268895Medicaid
1911709OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1911709OtherNCPDP PROVIDER IDENTIFICATION NUMBER