Provider Demographics
NPI:1518527977
Name:PAPA'S FARMACIA VIA LUZIANNA LLC
Entity Type:Organization
Organization Name:PAPA'S FARMACIA VIA LUZIANNA LLC
Other - Org Name:PAPA'S FARMACIA VIA LUZIANNA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, PRESIDENT, PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANNE SCHATZLE
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RGX, RPH
Authorized Official - Phone:225-243-5100
Mailing Address - Street 1:PO BOX 86061
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-6061
Mailing Address - Country:US
Mailing Address - Phone:225-243-5100
Mailing Address - Fax:225-347-5350
Practice Address - Street 1:25831 WALKER SOUTH RD STE 1
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726
Practice Address - Country:US
Practice Address - Phone:225-243-5100
Practice Address - Fax:225-347-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2207130Medicaid