Provider Demographics
NPI:1548242175
Name:MESHELLS HOME RESPIRATORY MEDS LLC
Entity Type:Organization
Organization Name:MESHELLS HOME RESPIRATORY MEDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-217-1308
Mailing Address - Street 1:2880 N HIGHWAY 171
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-4330
Mailing Address - Country:US
Mailing Address - Phone:337-217-1308
Mailing Address - Fax:337-217-1235
Practice Address - Street 1:2880 N HIGHWAY 171
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-4330
Practice Address - Country:US
Practice Address - Phone:337-217-1308
Practice Address - Fax:337-217-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA331931585XOtherBCBSL PROVIDER NUMBER
LA1271586Medicaid
LA4490400001Medicare NSC