Provider Demographics
NPI:1497848659
Name:ARCHIE CHAUVIN
Entity Type:Organization
Organization Name:ARCHIE CHAUVIN
Other - Org Name:LYDIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUVIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-369-6156
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:LYDIA
Mailing Address - State:LA
Mailing Address - Zip Code:70569-0435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3917 DARNALL RD
Practice Address - Street 2:
Practice Address - City:LYDIA
Practice Address - State:LA
Practice Address - Zip Code:70569-0435
Practice Address - Country:US
Practice Address - Phone:337-369-6156
Practice Address - Fax:337-365-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LA000687-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1227285Medicaid
2028918OtherPK