Provider Demographics
NPI:1508095407
Name:NEW LIFE PHARMACY LLC
Entity Type:Organization
Organization Name:NEW LIFE PHARMACY LLC
Other - Org Name:NEW LIFE PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:TENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-275-2425
Mailing Address - Street 1:PO BOX 45276
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70895-4276
Mailing Address - Country:US
Mailing Address - Phone:225-275-2425
Mailing Address - Fax:225-275-2427
Practice Address - Street 1:234 LITTLE JOHN DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-6124
Practice Address - Country:US
Practice Address - Phone:225-275-2425
Practice Address - Fax:225-275-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA61483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1934668OtherNCPDP PROVIDER IDENTIFICATION NUMBER