Provider Demographics
NPI:1487831483
Name:CITY APOTHECARY
Entity Type:Organization
Organization Name:CITY APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILDENBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:318-388-4747
Mailing Address - Street 1:312 GRAMMONT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7457
Mailing Address - Country:US
Mailing Address - Phone:318-388-4747
Mailing Address - Fax:318-388-4849
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-388-4747
Practice Address - Fax:318-388-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9945332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1208698Medicaid
LA38166OtherBLUE CROSS OF LA
LA0229080001Medicare NSC