Provider Demographics
NPI:1558756742
Name:SOUTH CENTRAL LA HUMAN SERVICES AUTHORITY PHARMACY
Entity Type:Organization
Organization Name:SOUTH CENTRAL LA HUMAN SERVICES AUTHORITY PHARMACY
Other - Org Name:SOUTH CENTRAL LA HUMAN SERVICES AUTHORITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:985-858-2931
Mailing Address - Street 1:521 LEGION AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-3339
Mailing Address - Country:US
Mailing Address - Phone:985-857-3748
Mailing Address - Fax:985-858-2934
Practice Address - Street 1:1809 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3336
Practice Address - Country:US
Practice Address - Phone:985-652-6311
Practice Address - Fax:985-652-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
LAPHY.005309-INX261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1558756742OtherNPI