Provider Demographics
NPI:1528412400
Name:PHARMACY CENTRAL LLC
Entity Type:Organization
Organization Name:PHARMACY CENTRAL LLC
Other - Org Name:BELLINGRATH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-315-0212
Mailing Address - Street 1:17070 GREENWELL SPRINGS RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-3928
Mailing Address - Country:US
Mailing Address - Phone:225-508-4977
Mailing Address - Fax:225-478-8319
Practice Address - Street 1:17070 GREENWELL SPRINGS RD STE B
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-3928
Practice Address - Country:US
Practice Address - Phone:225-508-4977
Practice Address - Fax:225-478-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY.007303-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159620OtherPK
LA2204459Medicaid