Provider Demographics
NPI:1578508164
Name:CRESCENT CITY PHARMACEUTICALS INC
Entity Type:Organization
Organization Name:CRESCENT CITY PHARMACEUTICALS INC
Other - Org Name:HOSPITAL DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:504-524-2254
Mailing Address - Street 1:2716 PIEDMONT ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-4920
Mailing Address - Country:US
Mailing Address - Phone:504-524-2254
Mailing Address - Fax:504-528-9310
Practice Address - Street 1:2716 PIEDMONT ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-4920
Practice Address - Country:US
Practice Address - Phone:504-524-2254
Practice Address - Fax:504-528-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA060303332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309966Medicaid
LA0451640001Medicare NSC