Provider Demographics
NPI:1578796140
Name:SLIDELL PHARMACY LLC
Entity Type:Organization
Organization Name:SLIDELL PHARMACY LLC
Other - Org Name:SLIDELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BEI-PALERMO
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:985-288-0099
Mailing Address - Street 1:1115 REBECCA REID DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-2015
Mailing Address - Country:US
Mailing Address - Phone:985-641-2660
Mailing Address - Fax:985-641-2677
Practice Address - Street 1:1201 ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-288-0099
Practice Address - Fax:985-641-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6166333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1934694OtherNCPDP PROVIDER IDENTIFICATION NUMBER
LA1235237Medicaid