Provider Demographics
NPI:1598179384
Name:OCHSNER PHARMACY AND WELLNESS LLC
Entity Type:Organization
Organization Name:OCHSNER PHARMACY AND WELLNESS LLC
Other - Org Name:OCHSNER PHARMACY AND WELLNESS - PRIMARY CARE AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO / EVP
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HULEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-842-3400
Mailing Address - Street 1:PO BOX 54696
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4696
Mailing Address - Country:US
Mailing Address - Phone:504-842-8310
Mailing Address - Fax:504-842-8315
Practice Address - Street 1:1401 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2426
Practice Address - Country:US
Practice Address - Phone:504-842-8310
Practice Address - Fax:504-842-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
LAPHY006907RC3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146532OtherPK
LA2202944Medicaid