Provider Demographics
NPI:1497164206
Name:ALPHAMED CORPORATION, LLC
Entity Type:Organization
Organization Name:ALPHAMED CORPORATION, LLC
Other - Org Name:ALPHAMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:S
Authorized Official - Last Name:COUSIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:985-445-3154
Mailing Address - Street 1:PO BOX 2231
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-2231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5128 LAPALCO BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4249
Practice Address - Country:US
Practice Address - Phone:985-445-3154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA154223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy